Sean Creighton

Sean Creighton serves as vice president for Federal Policy at Humana, a leading health care firm. Sean provides leadership in the development and implementation of federal policy strategy. Prior to Humana, Sean works for 3 years as Managing Director and head of policy analytics at Avalere, a premier consulting firm focused on health care. Sean led projects in a number of key areas, Part D reform, risk adjustment and RADV, and analysis of Medicare Advantage performance relative to FFS on cost, quality and utilization. Sean also spent 2 years as SVP for risk adjustment product at Verisk Health (now Cotiviti) working on data aggregation, coding, and submission products for Medicare and the commercial market to ensure appropriate revenue and elevate performance.

Before joining Verisk Health, Creighton was the deputy group director of the Payment Policy and Financial Management Group in the CMS Center for Consumer Information and Insurance Oversight. He also served as the director of the division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group in the Center for Medicare.

While at CMS, Creighton was responsible for payment policy and operations for both private marketplace and Medicare plans. Notable accomplishments include developing and implementing a system to make advance premium-tax credit and cost-sharing reduction subsidy payments to marketplace issuers under the Affordable Care Act; developing and implementing Parts C and D risk adjustment models; and serving as the sponsor and chief architect of the Medicare Encounter Data System (EDS).

Creighton holds a Bachelor of Arts degree in European studies from the University of Limerick, a Higher Diploma in Statistics from Trinity College, Dublin, a Master of Science degree in Sociology from the London School of Economics, and conducted doctoral research at Indiana University, Bloomington. He has won numerous awards for development and implementation of risk adjustment and payment models.