Amy Smith takes her health seriously, so when her employer offered discounts on health insurance premiums for taking steps to get healthier, she jumped at the opportunity.
''I was excited about having the money off, and I definitely needed to have some structure to my weight loss efforts,'' said Smith, an administrative assistant for the University of Minnesota Press.
Smith is one of more than 5,700 university employees who will receive at least a $300 discount on health insurance premiums in 2013 for participating in activities including a health risk questionnaire, health coaching and a biometric screening to measure blood pressure and cholesterol.
As Minnesota workers weigh their health insurance options for next year, more are being offered financial incentives to participate in wellness programs that monitor their health. And that's raised concerns about workers' privacy rights.
Basic health incentives, such as a discount for a gym membership, aren't new. About 90 percent of companies offer some kind of health incentive, said Nico Pronk, vice president for Health Management at HealthPartners, a nonprofit, member-governed health plan based in Minneapolis.
The simpler programs, such as an online questionnaire, likely aren't enough to change people's behavior, Pronk said, so the more comprehensive programs have been catching on. They include a range of activities — everything from weight-loss management to nutrition coaching.
"When we then look at these comprehensive solutions, it is less than 10 percent of companies that actually do those. So this is a major issue when you think about the effectiveness of these programs," Pronk said.
In the past, the University of Minnesota offered employees $65 in cash to complete a few activities. Starting this year, the university added activities and upped the reward. Employees must earn 300 points to get the health premium discount. For example, the online health questionnaire earns 100 points; commuting to campus by bike is worth 75, and setting a personal fitness goal like running a marathon can earn 50 points.
Dann Chapman, the university's employee benefits director, said officials have been getting the word out about the program in a variety of ways. But he thinks participation will rise dramatically next year as more people find out about it.
''It's a substantial help, and as that word gets out and people are realizing what a difference that can make, more people are paying attention and saying, 'how come I didn't know about this?'''Chapman said.
The university, which is self-insured, wants a high participation rate, because the program helps save on health care costs, including avoiding hospitalizations.
''Every extra dollar that gets spent paying for health care takes away from the university's ability to do its core mission, so we are very aggressively managing our trend,'' Chapman said.
He said a health economist who analyzed the university's health care costs concluded the wellness program gives the university a $1.76 return on its investment. "It's going extremely well," Chapman said.
But dramatically increasing participation rates won't come without challenges. The university covers 38,000 employees and dependents, and some are concerned about their privacy — even though university officials make it clear the data is collected by a third party and comes back to them only as an aggregate, making it impossible to identify individuals.
Smith, the University of Minnesota Press employee, said participating in the health questionnaire and biometric screening can feel "a little creepy."
"I think that if I were not already enthusiastic about taking care of myself, I might not feel as positive about the program," she said.
More than a dozen people from MPR's Public Insight Network from the U of M and elsewhere expressed privacy concerns about their employers collecting such data.
"What do they need that information for? What do they need to know my cholesterol rating for in order to know I'm doing a good job?" asked Andrea Lorek Strauss, a U of M extension educator in Rochester. "Now if it were correlated with my health provider, that feels a little more connected to me."
Deven McGraw, who directs the Health Privacy Project at the Center for Democracy and Technology in Washington, D.C., said it's smart for employees to ask questions about such data collection. But she said most employers want to use the data to better manage health care costs.
"That actually means it's in their best interests to make strong commitments to their employees not to use the data for any purpose that involves their employment, because why would you, as an employee, be truthful on a survey or take one to begin with if you had any doubts about how they would use the data?" McGraw said.
She suggests employees concerned about privacy ask their employers for more information about who is collecting and analyzing the information, because if it is collected by the health provider it's subject to patient privacy laws. If the employer collects the information, no specific law protects individuals' information, unless it involves a disability covered by the Americans with Disabilities Act.
As health care premiums continue to rise, employees will have more reasons to join incentive-based wellness programs. Not only are the programs likely here to stay, but health insurers say employers want to take it a step further to reward employees not just for participation, but for results.
''This is where value-based approaches get a little edgy,'' said Scott Reid, vice president of product strategy and development for Medica, a nonprofit health insurance company based in Minnetonka. "It's a grey area from a legal perspective in how far employers can go in asking their employees to actually make improvements to qualify for certain levels of rewards."
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