Latest / Becker’s Healthcare Podcast / Caswell Samms III, Executive Vice President and CFO of Nemours Children’s Health

Transcript

Caswell Samms III, Executive Vice President and CFO of Nemours Children’s Health · Becker’s Healthcare Podcast

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  This is where health care leadership comes together.
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  Becker's sixteenth annual meeting brings more than 3,500
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  hospital and health system executives and nearly 800
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  speakers to Chicago April.
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  This series event includes keynote conversations with Dallas
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  Cowboys legend Troy Aikman and former president George
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  w Bush. For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  in Chicago.
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  This is Madeline Ashley with the Becker CFO
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  and Revenue Cycle podcast, and I'm excited to
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  be joined today by Caswell Sams, executive vice
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  president and CFO of Nemours Children's Health. Caswell,
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  thanks so much for being on with me
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  today.
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  Thank you for having me. Looking forward to
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  the discussion today. Me too. And happy 2026
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  to you as well.
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  Yes. Happy New Year to you as well.
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  Wonderful. So, now we've had you on the
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  podcast before, but for those who, did not
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  have the pleasure of listening to our first
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  discussion, do you mind sharing just a little
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  bit about yourself and Nemours with our with
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  our listeners?
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  Sure. I'll be excited to. Caswell Sams. I'm
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  the executive vice president and chief financial officer
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  for Nemours Children's Health.
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  Been working in health care finance for over
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  twenty five years. Started my health care career
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  consulting.
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  Decided real quickly,
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  that I did not wanna be in consulting.
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  I actually wanted to work for a provider,
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  so I joined the provider side shortly after
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  that, and just continued to grow my career,
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  and I'm excited as of,
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  March
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  2025
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  to be a part of the Nemours Children's
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  Health Leadership Team.
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  And do you mind just sharing a little
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  bit more about Nemours with us as well?
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  Sure.
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  Nemours is the only multistate
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  pediatric
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  health system in The United States. We provide
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  a multitude of different,
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  provider based services,
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  primary care, prevention, and health.
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  We have two hospitals, and our main and
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  primary markets that we operate in are in,
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  Delaware and the surrounding states, as well as
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  the state of Florida.
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  We have over 10,000
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  associates,
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  1,100
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  employee physicians
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  operating
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  80 different locations,
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  provide
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  more than,
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  you know, 2,200,000
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  patient encounters on an annual basis.
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  And our ultimate goal as we continue to
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  provide for all children
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  is to create the generation
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  of the healthiest children in the world through
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  our whole child health strategy that we have
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  here at Nemours. Yeah.
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  Incredible. Thank you for sharing that background.
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  So let's dive in. I know we just
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  said it's the new year entering a whole
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  new
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  cycle. So as we are now here in
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  2026,
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  could you share maybe some financial trends or
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  shifts that you're keeping a close eye on
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  from your perspective
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  and why you're watching me so closely?
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  Yeah. I think when you have an organization
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  like Nemours, especially a pediatric health system
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  that has a large portion of Medicaid services
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  and patient population
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  that it provides.
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  Our our focus is on things that can
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  impact inflation as well as reimbursement
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  growth for the organization,
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  as well as how do we provide access.
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  So I'm quite sure these are top of
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  mind for
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  every organization.
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  Number one, what's gonna happen with the three
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  forty rebate model? Obviously,
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  that continues to be litigated, and hopefully, providers
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  come out on top. Lesser to the case,
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  the ACA subsidies, but we do believe as
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  a pediatric health system, there may be a
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  halo effect
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  on the pediatric services that organizations have. So
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  we're continuing to monitor that as well. And
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  then, how do we
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  mitigate
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  the potential growing impacts of HR one? So
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  we're continuing to see what we can do
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  either from an advocacy perspective or an education
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  perspective to our government officials on providing
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  those type of educations that they need on
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  the implications that it has on pediatric health
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  systems.
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  Yeah. One of the top things that we're
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  focusing on for 2026
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  is,
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  purposeful growth.
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  Not just growing to just grow, but purposeful
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  growth. And, you know, how do we implement
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  new technologies and get more efficient as an
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  organization?
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  Mhmm. And to to kind of follow-up there,
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  when we connected on the podcast in I
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  believe it was 2025,
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  you said Nemours
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  wasn't in, quote, panic mode, you know, despite
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  some of the uncertainties
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  tied to HR one or, you know, more
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  commonly known as the one big beautiful bill
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  act. So, how has that steady approach you
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  and I discussed kind of held up, and
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  what have you maybe learned since then?
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  No. I would probably say we are still
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  not going to take our eye off our
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  strategy. We're gonna still move full steam ahead
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  as an organization.
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  Again, we're gonna monitor. We're gonna advocate. We're
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  gonna continue to do what we believe is
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  best for the organization, partnering with the different
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  hospital associations we have. So that from a
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  strategy perspective has not changed for us. We're
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  gonna continue to do the things that we
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  believe we need to do
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  as it represents our mission from as an
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  organization, as well as our strategy to make
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  sure we create the healthiest generation of children
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  moving forward, and our focus around the whole
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  child health is gonna help us do that.
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  So we understand that, hey. Things are gonna
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  change. We're preparing to do what we need
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  to do internally to mitigate any potential negative
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  impacts on the organization. So we're not gonna
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  continue
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  to rest on our laurels, but we're gonna
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  continue to see what we can do to
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  say what what type of impacts do we
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  need to make or changes we need to
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  make and provide that education to our board,
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  our leadership team, and prepare for potentially negative
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  outcomes in the future. But we believe we
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  have a very solid strategy to help address
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  those issues,
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  but can continue to monitor and advocate as
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  we need to, to make sure that pediatric
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  health systems get the, you know, most appropriate
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  fair reimbursement on the Medicaid population that they're
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  servicing.
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  Right. Essentially, you're ready for anything
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  Very true. That it has to throw you.
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  Well, you also just talked about purposeful growth
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  this year. So could you dive a little
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  deeper into what that looks like and maybe
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  you see where you see some of the
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  biggest opportunities for this type of smart growth?
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  Yeah. I think for us, we're looking at
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  our markets and saying, hey. What do we
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  need to grow? How do we leverage the
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  clinical data we have? How do we understand
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  the community needs?
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  How do we deepen our payer partner ships
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  either through value based and risk aligned arrangements?
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  Number one, in our Delaware market,
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  we have what's called a global budget where
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  essentially
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  we're going to cap our own dollars and
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  take a little bit more risk in the
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  near future with the state of Delaware on
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  the Medicaid and the Medicaid HMO population. So
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  how do we create that value based strategy
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  and make sure we bring more value
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  than just utilization
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  and unnecessary utilization
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  into our Delaware market.
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  On top of that, we're still focusing on
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  those services that need to
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  have a positive impact on the Delaware market
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  as well. So the expansion of our
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  Lisa Dean Mosley Foundation Institute for Cancer and
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  Blood Disorders.
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  We're excited about the opportunity for more patients
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  in this market
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  not to have to leave the market for
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  cancer services. So that is gonna that is
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  a state of the art service that we're
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  expanding
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  in this market. The other expansion that we're
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  doing is our advanced delivery unit in this
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  market, mostly related to maternal fetal medicine interventions
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  that need to have for stable
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  obstetric patients in the Delaware Valley market. I
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  think it's a great opportunity for the patient
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  population not to have seek services out of
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  this immediate area and be able to come
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  to Nemours and not only for us to
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  be able to take care of the neonate
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  perspective of the
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  of the child, but also
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  provide those services that a mother may need,
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  who may be in need of their perinatology
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  services here at Nemours as well. So we're
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  excited about that continue to grow for us.
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  Yeah. And in, 2025,
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  I covered a a good amount of just
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  maternity care closures
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  in general.
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  But, do know that Nemours has been, you
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  know, making major investments in these areas just
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  in terms of child and, you know, mother.
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  So how important is that, to your organization
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  and just the continued growth there?
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  Yeah. For Nemours, I think this is critical.
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  You know? We're not looking at just traditional
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  obstetric expansion.
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  Yep. But we believe that this is gonna
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  be a way for us to stabilize what's
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  happening across the maternity market.
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  You know, there's a lot of safety nets,
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  a lot of,
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  as you pointed out, to have maybe some
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  some fragmented
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  impacts on how they handle high risk pregnancy
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  for us. You know, we're looking at the
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  upstream impact,
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  identifying risk earlier,
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  serving, seeing as a regional anchor for high
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  acuity maternal and neonate care, and then taking
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  an approach that, hey. We're gonna stabilize
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  this pediatric
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  service by creating a
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  more predictable pipeline for our NICU,
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  addressing complex pediatric care by also creating that
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  continuity for pregnancies
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  through,
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  you know, high risk opportunities.
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  And, you know, it's not about chasing volume.
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  It's about delivering high quality of care. So
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  we're not looking at this from a numbers
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  perspective. We're looking at it from more of
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  a holistic service line perspective.
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  Yeah. No. That's great to hear. And, you
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  know, just amid, you know, plans to grow
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  and as we just touched on a little
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  bit earlier, some of the uncertainties that we
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  are seeing in the industry.
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  From your perspective, what leadership mindset will be
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  most important for financial leaders navigating 2026?
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  Yeah. I think it's gonna be critical,
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  for
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  financial leaders to have a different perspective.
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  I don't think we can continue to operate
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  as financial scorekeepers.
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  We're gonna have to be more strategically
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  engaged,
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  very fluent on clinical operations,
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  technology,
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  artificial intelligence,
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  quality, and just workforce dynamics. I think that
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  means, as a financial leader,
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  a little bit of rigor and empathy is
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  gonna create a lot of
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  longevity for your organization.
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  Adding that with, you know, making sure you
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  can make decisive
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  decisions with adaptability
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  as it's needed. Mhmm. You know, I think
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  that's gonna help CFOs who, you know, might
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  need clarity in in uncertain times because we
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  never know what's gonna be the next
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  potential
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  hill we have to climb as we move
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  forward in 2026.
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  I think that helps bring
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  confidence to your the rest of the executive
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  team members as well as the board,
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  because, you know, we're gonna continue to make
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  informed data driven decisions.
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  But, you know, we know that the the
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  path is not perfectly clear moving forward, but,
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  we're gonna continue to make informed decisions as
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  a leadership team and and continue to make
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  sure that whatever we do is just not
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  to grow to grow, but it's for purposeful
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  growth reasons.
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  Yeah. Yeah. And you touched on technology. Is
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  there, you know, a piece technology, a tool
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  right now, or just an area that you
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  are personally keeping an eye on?
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  Yes. I mean, we are continuing to make
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  strategic and investments for us of our advanced
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  care at home program that we're having, which
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  is kinda more of a telehealth medicine model.
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  We believe we've had a number of early
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  successes with it,
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  especially in our Florida market to kinda keep,
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  patients out of the emergency room, keep our
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  patients
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  discharged earlier from our PICCI or our NICU.
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  And, you know, because of the reach we
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  have and people seeking, you know, specialized services,
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  we have, you know, families who may travel
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  seventy, ninety miles. Imagine as a mother or
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  a father, you don't have to travel, and
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  you can kinda just
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  log in to, a telemedicine system and have
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  a discussion with a nurse and be able
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  to, you know, alleviate any concerns you may
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  have instead of having an unnecessary visit in
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  the emergency room. So we're we're significantly invested
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  and can see and that continue to grow,
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  and we actually just implemented that in our
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  Delaware market as well.
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  Wow. Now those I mean, the technologies we're
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  seeing right now are so incredible. So definitely
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  worth keeping an eye on. Final question for
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  you here.
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  Looking at 2025,
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  what's one lesson that you learned that you're
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  looking to carry into the new year?
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  I'd probably say we have to move faster.
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  And then move faster, making informed decisions.
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  You know, I think the volatility that we
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  experience from a, you know,
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  a a a governance or a government perspective
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  is gonna continue to create challenges for us.
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  So, you know, we're looking at our capital
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  allocation.
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  We're making sure we're aligned as a leadership
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  team, but we definitely have to move faster
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  and continue to make
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  informed but better decisions. So we're gonna double
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  down on our fundamentals. You know? We're gonna
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  be as agile as we possibly can.
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  We trust our leadership team to make informed
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  decisions.
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  We're gonna have the appropriate financial durability that
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  we need,
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  you know, which is no longer an option
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  in health care. And, you know, I think
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  that'll continue to help us make sure we
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  serve our mission in a way that we
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  wanna serve, which is all about our whole
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  child health. Yeah. Well, Caswell, as always, it
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  has been such a pleasure getting to chat
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  with you and hear about all the exciting
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  things going on at Nemours.
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  Really looking forward to hopefully connecting again soon.
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  So I appreciate you taking the time.
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  Thank you.