Erin Sutton

Erin Sutton is the Deputy Director for the Office of Program Operations and Local Engagement, Drug and Health Plan Operations. She leads the administration of the Medicare fee-for-service program at the regional level to protect over 60 million beneficiaries, supports over 400 health plans through oversight of Medicare Advantage and Marketplace organizations and ensures the Medicare program’s fiscal integrity. Erin has served at CMS and in the private sector for more than 18 years and has held numerous positions throughout the agency, primarily focused on Medicare Advantage and Marketplace, Program of All-Inclusive Care for the Elderly (PACE), Part D, special needs products, the intersection of managed care markets, and the No Surprises Act.  During her OPOLE tenure, she has led a functional reorganization of 300 staff, reduced misleading marketing, and improved customer quality and service turnaround across Medicare Advantage and Marketplace for hundreds of thousands of consumer issues each year. Erin’s team also leads regular executive health plan discussions addressing operational issues impacting millions of consumers and delivery of services with taxpayer dollars.

Prior to joining OPOLE, Erin served as the Deputy Group Director for Payment Policy and Financial Management Group in the Center for Consumer Information and Insurance Oversight, where she created premium stabilization programs and oversaw billions of payments to issuers on and off the Marketplace, and launched the first ever ‘interim reports’, data sets and peer-reviewed articles giving more public access to risk adjustment information.  During this role, she also served in the CCIIO Front Office, working collaboratively in leading the launch of the No Surprises Act alongside the Department of Labor & Treasury Internal Revenue Service; providing early parameters for transparency and consumer relief and protection from surprise medical bills through the patient-provider dispute portal. Erin has served in successive leadership positions, including division director for risk adjustment operations, pre-existing insurance programs, and bundled payments. Additionally, Erin served at the Office of Legislation and as a special assistant to executive leaders in the Center for Medicare (CM) working across Medicare Advantage and Part D fee-for-service programs and detailed at the Office of Management and Budget in the Medicare branch. Prior to CMS, Erin held roles at Avalere Health LLC; a national managed care organization and provider and patient health delivery organizations focused on Medicare, Medicaid, and commercial markets. She holds an undergraduate degree from the University of Tennessee and a Master’s in Public Health Management from the George Washington University.