Penny Edlund
RN, BSN, MBA, CPHQ
Senior Healthcare Management Consultant
Seattle, WA, US
Penny Edlund is a healthcare management consultant in the Seattle office of Milliman. She joined the firm in 2019.
Experience
Penny is a results-oriented, customer-centric health care executive committed to improving quality of care, clinical outcomes, affordability, and revenue growth in a dynamic, highly competitive environment.
She has more than 25 years of healthcare leadership experience, which includes acute care, long term, skilled nursing and subacute care, managed care, medical management and population health with a focus on strategy, innovation, design and implementation, clinical operations, outcomes, and performance assessment and improvement.
She has extensive managed care leadership experience with Medicare, Commercial, and Medicaid populations. Her responsibilities have included:
- Leading medical management services, including utilization management, care management and population health programs
- Implementing medical/behavioral care integration, service, and operations
- Leading collaborative initiatives across multidisciplinary stakeholders to improve quality, efficiency, effectiveness and coordination of clinical services
- Designing and implementing innovative approaches to improve care and reduce costs (e.g., readmission reduction, emergency room utilization, opioid use disorder, HEDIS initiatives)
- Preparing regulatory and accreditation surveys and their results
- Conducting strategic planning, business development, product innovation and RFP responses
Publications and Presentations
- Clinical Assistant Professor, University of Washington, MHA Program. November 2019–present
- Board Member, Project Access Northwest. Jan 2017–present
- Executive Committee Member, Puget Sound Asthma Coalition (2017–2018)
- Presenter: California Association of Health Plans (CAHP) (2004)
- Panel Member: CAHP Obesity Initiative Workgroup (2005–2006)
- Member: Institute for Healthcare Improvement
- Member: National Association for Healthcare Quality
Education
- BSc Nursing, University of Toronto
- MBA, Pepperdine University
- CPHQ, Certified Professional in Healthcare Quality
Publications
Read their latest work
Article
Evaluation of the savings methodology for the HCSC Health Advocacy Solutions program
19 December 2022 - by Troy M. Filipek, Todd Wanta, Anders Hendrickson, Penny Edlund, Maureen Tressel Lewis
We examine a provider’s savings methodology for its clinical program, giving insight on opportunities to more accurately measure intended cost reductions.
Article
Health equity data strategy and applications in Medicaid managed care
13 May 2022 - by Paul R. Houchens, Penny Edlund, Libby Bunzli
A summary of available data sources that can assist state Medicaid agencies in evaluating health disparities and measuring progress toward health equity goals
Article
Care management for Medicaid: Optimizing new models of care for better population health and lower costs
08 November 2021 - by Penny Edlund
Design and implementation of new care models mean a major undertaking for many plans, yet optimizing their value could bring substantial rewards for MCOs.
Article
Racial disparities in cardiovascular conditions
05 April 2021 - by Penny Edlund, Anikia Nelson, Melody Craff, Maureen Tressel Lewis
Our study of racial disparities in cardiovascular disease contributes new research and approaches toward achieving healthcare equity.
Article
Pursuit of accreditation – What, why, and how
23 July 2020 - by Barbara Culley, Penny Edlund, Maureen Tressel Lewis
This paper provides information about the pursuit of quality accreditation as an essential investment that can have a positive impact on multiple health plan priorities, including quality of care, member satisfaction, and market viability.
Article
Leveraging health plan medical management teams during the COVID-19 pandemic
15 April 2020 - by Penny Edlund, Maureen Tressel Lewis
Where can a health plan’s medical management team contribute to the COVID-19 response?