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By JULIE LIEDMAN, a Philadelphia-based author who writes for national magazines

She's a force to be reckoned with, Vicki Robinson, a short, trim woman ubiquitously dressed in a dark, conservative suit, the quintessential picture of a city risk manager.

"The first thing anyone said when they come into my office is, 'OK, let's see the nails," Robinson said with a laugh.

But don't get the wrong idea about Vicki Robinson. In this 24-hour city of glittering lights and countless Elvis impersonators, Robinson may not take herself particularly seriously, but she takes her job as Las Vegas' manager of insurance services very seriously. The well-being of the 3,000 Clark County employees under her purview is never far from her mind nor is her desire to keep healthcare costs down by encouraging healthy lifestyle choices.

"I'm constantly thinking about how I can help people," she said. "It's almost like social work."

In fact, Robinson had intended to go into social work back when she was a student at Syracuse University. She wanted to help the injured and disabled re-enter the workforce.

But in her very first social work class, she learned that she was making more at her job in the finance department at Corning Glass Works, where she worked while attending college, than she could ever hope to make as a social worker, and she immediately changed her major from social work to finance.

While at Corning, Robinson learned all about workers' compensation "and learned that I liked it a lot.

"I love that it changes on an almost daily basis," she said. "You may have the same claim over and over--but it's never the same claim.

"It's a strategy game sometimes," she said. "I love the legal aspect, looking at statutes and determining what kind of benefits would be paid under what statutes. It's different every time."

Robinson moved to Las Vegas from upstate New York in the mid-1990s, after she and her husband came for vacation and fell in love with the place.

BLUR AND BLOOD

She went to work for the city in 1996 as a senior analyst in workers' comp, and by the following year she was head of a new division that included not just workers' comp but everything from liability and safety to group health and property. The learning curve was steep.

"I was like a deer in the headlights," said Robinson. "1997 was a blur for me."

But learn she did. In 1998, the city management decided to move from a fully insured health plan to self-insurance. It then experienced five years of tremendous growth in costs. With 15 percent to 20 percent cost growth each year, the city was estimating that group health costs would reach $44 million in 2010.

"There was blood on my pillow," Robinson recalled. "I was constantly biting my lips at night, trying to figure out how to stem the rising costs."

So Robinson decided to look into a consumer-driven healthcare plan--a health insurance plan that allows members to use personal health savings accounts (HSAs), health reimbursement accounts (HRAs) or similar medical payment products to pay routine healthcare expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses.

In 2004, Las Vegas became the first municipality to roll out a consumer-driven healthcare plan. Today, it has one of the most successful plans, with 80 percent participation, Robinson said.

"Our employees love it," she said. "They took to it like ducks to water."

Why?

"The most effective thing we did, I think, was the elevator speech," said Robinson. "My benefits administrator and I would get on the elevator in City Hall and ride to the 10th floor, talking about it. As people got on and off, they kept hearing snippets.

"By the time the actual education started, a lot of people already knew about consumer-driven health care. Then there were all kinds of educational pieces--there was nine months of education."

At first, everything seemed to go smoothly. During the first few months, Robinson and staff stopped getting complaints from employees about payment delays and other problems related to their previous third-party administrator.

"Some people were patting themselves on the back," said Robinson. "But I kept reminding them that three months don't a trend make."

Eventually, employees took a look at their EOBs (explanation of benefits) and discovered that they were paying their doctors more than before. Robinson studied the issue. The problem? Their chosen network turned out to be strong on the East Coast, but not so strong on the West Coast. Robinson went with a new network.

"I like to say we changed because employees were paying attention," she said, "not because I was so smart."

THEN BIG SAVINGS

Then there was the problem of wellness coaching. Although telephonic coaching was offered, few people were taking advantage of it. So Robinson went out and found a company that would provide one-on-one wellness coaching on site.

"That's been a really, really successful program," she said. "We're always looking for ways to engage our employees. We're always trying to find fun, innovative things to do. For instance, we have a 'biggest loser' thing going, and now we've opened it up to spouses.

"It's been a major element in keeping our costs down," she added.

Last year, the city spent less for its healthcare program than it did in 2005, when the consumer-driven health plan first went into effect.

And this year--"the Lord willing and no preemie triplets are born," said Robinson--the city will spend under $23 million--far below the $44 million projected for 2010 five years ago.

"We've saved about $40 million since the inception of consumer-driven health care," said Robinson.

But she is not resting on her laurels.

"Everyone is sweating bullets," she said. "The city of Las Vegas is in major financial difficulty.

"Interestingly enough, there has been no serious discussion about ending my wellness program," she said. "Still, I will continue to work hard to justify it."

She has no doubt that she will be able to do it.

"I may be little," Robinson said, "but I'm loud."

May 1, 2010

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