Matt Marek, CEO at Blue Cross affiliate, on the growth of health savings accounts

The share of workers in health plans that offer health savings accounts jumped from 4 percent in 2008 to 19 percent last year, according to a Kaiser Family Foundation survey. The growth comes as rising health costs push more people into high-deductible health plans, said Matt Marek, the chief executive at Further, the business at Eagan-based Blue Cross and Blue Shield of Minnesota that administers health savings accounts. Called HSAs, the accounts let consumers use tax-preferred savings to pay for certain out-of-pocket medical costs. In May, the website HSA Report Card included Further in its list of 10 large HSA administrators. The Optum division at Minnetonka-based UnitedHealth Group topped the website's list with $8 billion in assets under management last year.

Q: What has growth been like over the last few years?

A: Further administers health spending and savings accounts for Blue Cross and Blue Shield of Minnesota, along with six other Blue plans and thousands of employers across the country. We have doubled the size of our business over the past 24 months as we have expanded our reach to more employers, more consumers and more health plan partners.

Q: Optum has grown its HSA bank in part through acquisitions. Has this been true at Further?

A: Similar to most of the top 10 HSA administrators, Further did acquire a few smaller blocks of business between 2011 and 2016, when some of the banks were uncertain of this space and divesting this business. … The market has really slowed in that regard. There's not a lot of consolidation and acquisition happening right now.

Q: What explains the growth?

A: The rising cost of care has driven employers and consumers to high-deductible plans. While the increase in adoption of high-deductible health plans is certainly part of our growth story, it's just one part. We have also been growing through health-plan partnerships and large employer relationships where our story resonates with what they are looking for in a partner.

Q: HSAs let consumers save the funds they don't use on health care. How often does that happen?

A: Less than 10 percent of customers with HSAs are focused on long-term savings. Rather, most of our members spend the money they are able to set aside each year and need help in making smart choices.

Q: Do you expect the business to continue growing?

A: Yes, we expect continued growth. With the rising cost of health care, we expect to see the burden of costs continue shifting to consumers. Due to this, it will be increasingly important for consumers to understand how to best use the money they set aside for health care spending. We see this as a great opportunity to continue to educate our members and help improve their health care and health finance literacy.

Q: In a recent report, the market-research firm Devenir said total HSA assets were $45.2 billion last year, up from $19.3 billion five years earlier. How many assets does Further now have under management? How does that compare with five years ago?

A: Further has more than $1.3 billion in assets under management, which is double what we managed just two years ago. I expect us to double again in the next 24-36 months.

Q: Is there any evidence to suggest that people who have an HSA use the health care system differently?

A: Yes. HSA members are far more likely to shop for care, and to use telehealth. They log in to their health plan portals far more frequently and are more engaged consumers as they have more "skin in the game."

Q: What information tools do members have so they can shop smartly with their HSA dollars?

A: No one wakes up excited to pay for health care expenses. Our role is to provide people with tools, information and resources like our comprehensive Learning Center so they can better understand their account and how to use it. This builds confidence in their health care spending so they can make faster decisions, and, ultimately, have time back to focus on the things in their life that matter. We connect our customers to services that allow them to shop for care, to find a doctor, to pay their bills and to be informed about the health care ecosystem.

Q: Can people actually see the negotiated price of service at different health care providers before they seek care?

A: Yes. The biggest challenge in providing these services is making customers aware that these services are available and getting them to use them.

While we have a great adoption rate and are increasing awareness daily, many members do not know what is available to them. That is a big part of what we do.

Q: Do people need to know the particular medical codes for the services they are seeking, in order to comparison shop? If so, how can they get the right codes?

A: No. Medical codes are not needed to comparison shop for services.