"If companies are promoting high-deductible products, they better be prepared," according to Lindsay Resnick, KBM Group principal. "Customers will be in control, talking about you, reviewing you, price checking you and recommending you (or not). They will have an abundance of choice and their experience as your customer will determine your value. Companies need to make sure every customer 'touch point' throughout the lifecycle is driven by an integrated communication stream that always seeks to deepen engagement and ultimately, promote loyalty."

Once again, as in the early 2000s, "consumers are being asked to ante-up and deal with intimidating, complex benefit and health care decisions. As they assume responsibility of their health care destiny and stay involved throughout care delivery, they need to be educated and supported to navigate these individual decisions. The obligation to make this happen falls squarely on the shoulders of employers and their payers, provider and broker partners."

According to Cindy Nayer, founder of the Center for Health Value Innovation, "Surveys are showing rapid growth in high-deductible health plans, both in the employer-sponsored market but also in the insurance exchanges. A recent survey showed that people are ready to purchase in the exchanges based on the premium amounts – they are not considering the out-of-pocket and deductible implications. While [PPACA] guards against cap-less out-of-pocket costs, there is still a medical OOP at $6,350, which may be a surprise to some enrollees in either employer-sponsored or exchange plans."

The good news is that there are essential benefits required in most of the plans (exceptions are the "grandfathered" employer plans) so folks can get their preventive and wellness exams/screens/care with no out of pocket charges. This is complicated for the providers, as they now are confused about who gets charged the $10-15-25 copays (grandfathered? most beneficiaries do not know). More disconcerting is that there has been little evidence that consumers choose more wisely with HDHP since they have "skin" in the game.

People who have chronic disease have not shown that they will become adherent to medication or tests/screens or lifestyle changes when they are in HDHP; they feel they're spending their own money (true) and therefore need to guard every dollar (yes, but it's much more expensive when the condition isn't controlled). One safety factor is that there's always the emergency room (that is, as long as there isn't overcrowding) so folks who ignore their daily care can use the ER.

Again, there's a potential problem of out of pocket costs at the ER if it's not emergency or if the attending physicians are not part of the network. Add to that lack of knowledge on the reduction in government reimbursement for unreimbursed care (paid through Medicare/Medicaid, it's known as the disproportionate share for hospitals). This means that hospitals and health systems, along with providers, are unsure of payment from consumers, government, and overlaps of both.

A simple concept such as electronic medical record that could link this kind of data for providers and systems becomes complicated in the general marketplace with so many vendors. Add to that the insecurity of financing from Capitol Hill. Top this off with the research that showed that consumers do not want to be concerned with the cost of care and they don't want their doctors to think about it either, and there can be a new perfect storm.

It's incumbent upon all stakeholders in the health care market to "keep the volume turned up on HDHP and the importance of meaningful and actionable data at the point of decision. It's not that HDHP are not valuable, but that consumers and providers are unsure of how they work and how the money flows. The participants must keep pushing for reliable systems in which providers can know how much they will be reimbursed within health plans and from exchanges/government. It's complicated. But it's not insurmountable," Nayer says.

So for those who want to be in the know, the IRS has released the 2014 limits for health savings accounts and HDHPs, according to Buck Consultants. While the deductible amounts remain unchanged from 2013, the out-of-pocket and contribution amounts have increased. Plan sponsors will want to review the impact of the limits on current and proposed HSA/HDHP arrangements, and update their plan documents and enrollment materials in anticipation of the new limits.

High-deductible health plans might not be for everyone. However, because of the pending tsunami of new participants into the insurance market, their undoubtedly are going to be a lot more players—carriers, plan administrators, employers, and plan members. The role of all stakeholders is to make sure that those who eventually purchase one understand how they work, what their out of pocket obligations are, and how much they might spend and save. It's times like these that make a good broker worth his weight in commissions.