Meet
Sean Creighton

Sean Creighton is responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.

His extensive experience with claims data and application of Avalere’s modeling and analytics functions enable him to advise clients on their strategic goals.

Prior to Avalere, Sean was a senior vice president at Verscend Technologies, where he led the development and management of risk adjustment products. Prior to that, he spent 15 years at the Centers for Medicare & Medicaid Services, leading the policy development and implementation of major public programs.

Sean holds graduate degrees in sociology and statistics from the London School of Economics and Trinity College, Dublin, Ireland, and a BA from the University of Limerick, Ireland.

Authored Content


In episode 1 of our series Fred Bentley, Sean Creighton, and Kenny Kan discuss the new supplemental benefits offered through Medicare Advantage plans for 2019.

Our analysis finds there will be winners and losers at the plan level under the new models.

Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.

MA plans expand coverage of supplemental benefits following administration’s policy change.

Following its recent announcement to grant Medicare Advantage (MA) plans the flexibility to use step therapy techniques for Part B drugs beginning in January 2019, the Centers for Medicare & Medicaid Services (CMS) released an FAQ with additional guidance on its implementation.

New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.

Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.

In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Advance Notice and Call Letter (ANCL), describing the Agency's proposed 2019 payment policies and other policy updates for the upcoming plan year for Medicare Advantage (MA) and Part D plans.

In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).

Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).

Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).

According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for stand-alone prescription drug plans (PDPs) will increase and the number of PDPs available in 2017 will decrease. Conversely, the Medicare Advantage market appears strong as 8 in 10 beneficiaries have access to MA plans that offer prescription drug benefits with a zero premium.

The Centers for Medicare & Medicaid Services (CMS) just released the annual Landscape Files containing data on plan participation, beneficiary premiums, and benefit designs for the 2017 Part D and Medicare Advantage (MA) markets. Avalere offers the following observations on key trends in the MA and Part D programs that are likely to influence the 2017 market.

In late August, CMS released its proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year.

In 2016, more than 18 of 56 million Medicare beneficiaries receive their benefits from Medicare Advantage (MA) plans. MA plans are private managed care organizations that contract with the federal government to coordinate care for Medicare beneficiaries.

New Avalere report identifies opportunities to refine the risk-adjustment model that could improve the way Affordable Care Act plans are paid

Percentage of Medicare Advantage enrollees in plans with at least four stars continues to grow.

A new analysis from Avalere Health finds that hospitals and health systems are increasingly taking risk for the cost of Medicare patients and the quality of the care they receive.

A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions.

Medicare Advantage HMO offerings grow while PPO and PFFS offerings are exiting the market. Analysis also shows significant variation in PDP premiums in 2014; five out of top 10 prescription drug plans have double digit increase