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Avalere Deepens Expertise in Medicare Advantage Payment Systems with Hire of Sean Creighton

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Sean Creighton has joined the Avalere team as a vice president in the policy practice, and will be responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.

Prior to Avalere, Creighton spent approximately 15 years at the Centers for Medicare & Medicaid Services (CMS), leading the policy development and implementation of major public programs. In addition to his deep content expertise, Creighton’s extensive experience with claims data will further bolster Avalere’s modeling and analytics functions.

Creighton held various roles during his tenure at CMS, and most recently served as the deputy group director of payment policy and financial management group, Center for Consumer Information and Insurance Oversight (CCIIO). In this position, Creighton was responsible for advising leadership on policy and technical issues related to the Affordable Care Act (ACA), in addition to overseeing implementation teams to ensure operational readiness of CCIIO’s payment systems and processes. He also worked with CMS contractors to develop the Department of Health and Human Services’ risk adjustment model and the ACA reinsurance model.

In previous roles at CMS, Creighton was also responsible for the development of payment policy and risk adjustment models for Medicare Advantage (MA) and Medicare Part D. Additionally, he led the annual process of developing a major regulatory and policy document that governs Medicare payment to health and prescription drug plans. Creighton also oversaw a team that developed and implemented ongoing analyses of Part C and D bids from MA and Part D plans.

“Sean comes to Avalere as an acknowledged national leader on outcomes-based payment systems,” said Dan Mendelson, president at Avalere Health. “His experience in designing risk-adjustment programs for Medicare Parts C and D, in addition to standing up the health insurance exchanges, will prove invaluable as our clients navigate health system reform.”

After working at CMS, Creighton was a senior vice president at Verscend Technologies where he led the development and management of risk adjustment products.

Creighton holds graduate degrees in sociology and statistics from the London School of Economics and Trinity College, Dublin, Ireland. Creighton holds a bachelor of arts degree from University of Limerick, Ireland.

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