Podcast Summary

Becker’s Healthcare Podcast

Episode: Caswell Sams III, Executive Vice President and CFO of Nemours Children’s Health
Date: January 9, 2026
Host: Madeline Ashley

Episode Overview

This episode features an insightful discussion with Caswell Sams III, EVP and CFO of Nemours Children’s Health. Caswell shares Nemours’ strategic financial outlook for 2026, addresses industry uncertainties—especially those affecting pediatric health systems—and explains purposeful growth, leadership mindset, and technology investments underpinning Nemours' mission to build the healthiest generation of children.

Key Discussion Points & Insights

1. Background on Nemours and Leadership (01:07–02:42)

• Caswell Sams’ Career Path:
  • Over 25 years in healthcare finance.
  • Transitioned from consulting to provider-side leadership; joined Nemours in March 2025.
• About Nemours Children’s Health:
  • Only multistate pediatric health system in the U.S.
  • Operates in Delaware, surrounding states, and Florida.
  • 10,000+ associates, 1,100 employed physicians, 80 locations, 2.2 million patient encounters annually.
  • Mission: “to create the generation of the healthiest children in the world through our whole child health strategy.” (02:34, Sams)

2. Financial Landscape & Key Trends for 2026 (03:03–04:27)

• Pediatric Focus & Market Dynamics:

  • High Medicaid exposure means reimbursement and inflation are critical factors.
  • Monitoring the ongoing litigation over the 340B rebate model and effects of ACA subsidies.
  • Concerned about legislative impacts of HR1 (“one big beautiful bill Act”), advocating and educating policymakers regarding Medicaid reimbursement.

  “Our focus is on things that can impact inflation as well as reimbursement growth for the organization, as well as how do we provide access.”
  — Caswell Sams (03:18)

• Purposeful Growth:

  • Emphasizes smart, strategic expansion, not growth for its own sake.
  • Organizational efficiency through tech adoption.

3. Resilience Amid Uncertainty: Strategic Steadiness (04:49–06:09)

• Stance on HR1 & Navigating Uncertainties:

  • Remains steady, not reactionary; focus on mission and long-term strategy.
  • Preparation, advocacy, and board education to withstand potential negative policy changes.

  “We’re going to still move full steam ahead as an organization… We’re not going to continue to rest on our laurels, but… prepare for potentially negative outcomes in the future.”
  — Caswell Sams (04:49, 05:05)

4. Purposeful Growth: Strategy in Action (06:24–09:35)

• Market and Service Expansion:

  • Uses data and community needs to guide expansion decisions.
  • Deepening payer partnerships, especially with value-based and risk-aligned arrangements.
  • Delaware market: Introduction of a global budget/risk-sharing for Medicaid/HMOs.

• Key Initiatives:

  • Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders:
    Expanding local access so families don’t need to leave the area for pediatric cancer care.
  • Advanced Delivery Unit:
    Enhancing maternal-fetal medicine and perinatology, allowing mothers and complex newborn cases to be cared for within the region.

  “It's not about chasing volume, it's about delivering high quality of care. We're not looking at this from a numbers perspective... more of a holistic service line perspective.”
  — Caswell Sams (09:26)

• Strategic maternity care investments described as crucial for stabilizing regional care gaps, especially for high-risk pregnancies.

5. Leadership Mindset for Modern Healthcare Finance (09:54–11:16)

• Transformation of Financial Leadership:

  • CFOs must go beyond traditional “scorekeeping” and be deeply strategic.
  • Importance of fluency in clinical operations, technology (notably AI), quality, and workforce trends.
  • Calls for “rigor and empathy,” adaptability, and decisiveness.

  “As a financial leader, a little bit of rigor and empathy is going to create a lot of longevity for your organization.”
  — Caswell Sams (10:19)

  “We know that the path is not perfectly clear moving forward. But we're going to continue to make informed decisions as a leadership team...”
  — Caswell Sams (11:02)

6. Notable Technology Investments (11:16–12:24)

• Advanced Care at Home:

  • Telemedicine program keeping patients out of the ER and enabling early discharge from intensive care units.
  • Successful in Florida and now expanded to Delaware.

  “Imagine as a mother or a father, you don’t have to travel and you can just log into a telemedicine system… instead of having an unnecessary visit in the emergency room.”
  — Caswell Sams (11:53)

7. Key Leadership Lesson from 2025 (12:39–13:29)

• Operational Agility & Informed Decision-Making:

  • Necessity for faster, more informed decision-making amid rapid change.
  • Emphasis on fundamentals, trust in leadership, and financial durability.

  “We have to move faster. Faster making informed decisions… we're going to double down on our fundamentals… and have the appropriate financial durability…”
  — Caswell Sams (12:43)

Memorable Quotes & Moments

• Mission-Driven Focus:
  "Our ultimate goal... is to create the generation of the healthiest children in the world through our whole child health strategy." (02:34, Caswell Sams)

• On Adapting to Uncertainty:
  "We’re going to continue to do what we believe is best for the organization... to make sure we create the healthiest generation of children moving forward." (05:05, Caswell Sams)

• Changing Nature of Financial Leadership:
  "I don't think we can continue to operate as financial scorekeepers. We're going to have to be more strategically engaged...” (09:54, Caswell Sams)

• On Technology as a Lifeline for Families:
  "Imagine as a mother or a father, you don't have to travel and you can just log into a telemedicine system and have a discussion with a nurse..." (11:53, Caswell Sams)

Timestamps for Major Segments

• Nemours Introduction & Mission – 01:07–02:42
• 2026 Financial Trends & Legislative Uncertainties – 03:03–04:27
• Staying the Course: Resilience in Uncertain Policy Environments – 04:49–06:09
• Purposeful Organizational Growth & Market Strategy – 06:24–09:35
• Future of Financial Leadership in Healthcare – 09:54–11:16
• Technology and Telehealth Investments – 11:16–12:24
• Key Lessons and Fast-Paced Decision-Making – 12:39–13:29

Conclusion

Caswell Sams shares a measured, mission-driven vision for Nemours Children’s Health in 2026, stressing purposeful growth, strategic resilience in the face of policy shifts, innovative care models, and the evolving role of financial leadership in pediatric healthcare. The conversation underscores the importance of adaptability, advocacy, and keeping patient-centered values at the fore as the landscape continues to evolve.