"There's been all kinds of interest in how to enhance the market of health care," he said. "The money goes for services rendered. There is gobs of information on the number and types of care that is purchased within the system. But there is a big disconnect on what happens to patients after the service has been provided."

Wheeler said medical homes have been compared to turning the system back to managed care. Medical care can have the most positive influence on a patient and best value for the money spent if it becomes a personal, ongoing, shared effort by a primary care physician in engaged collaboration with patients.

Proponents of medical homes say they wouldn't be tied to any single insurance or employer-provided benefit plan, and the few being tested currently don't require mandates for patient participation. But patients who do sign up with wellness plans of any kind offered by providers, hospitals, state agencies or city recreational programs are likely to abide by them and actually change risky behaviors if there were bottom line inducements. Premium prices and co-pay for doctor visits could be reduced, and money for making changes, such as so much per pound of weight lost entices people to health improving changes, they said.

David Sundwall, executive director of the state Department of Health, said patient behavior and attitudes run deep but aren't impervious to change.

"The phrase I heard most often and the one I hate the most to hear is, 'Whatever you say, doctor,"' Sundwall said. "I would way rather have a patient fully involved and fully participating, noting that most patients tend to be passive and want a quick fix with the least pain, cost and effort. These are not complicated changes in lifestyle that people would have to make," said Sundwall, who advises various health care organizations nationwide on individual responsibility. "They're simple steps, not even annual exams. Screenings for cancer risks, diabetes, blood pressure, steps that are critically important efforts to prevent illness.

"Seriously orienting toward prevention won't break the bank and still allow us to catch problems upstream before they become big, expensive problems we're paying for downstream," he said.

Lawmakers said that urging greater patient involvement in their own health is key to any reformed system, but it also sets up a delicate dilemma: How to induce people to be health conscious when habits they have — and probably really don't not want to give up — are the single biggest detriments to good health.

Mike Tanner, human resources manager at O.C. Tanner, said the jewelry manufacturing company has been incorporating the medical home model among employees by giving them reasons to participate for a number of reasons.

"We see as a business group that one of the biggest influences on the system's double-digit inflation is we've put the patient outside of the system," Tanner said. Low deductibles and low co-pays help create a sense that health care is a natural resource in infinite supply.

"For as much as health care costs, there is very little built-in personal responsibility paying for it or staying well."

The question is if the successes of these programs in place can be applied to all sectors of the system, said task force co-chairman Sen. Sheldon Killpack, R-Syracuse.

"Are we seeing a willingness on a major scale to change or are these models just another of a lot of small litmus tests that work in very specific situations but really don't fundamentally change the way things get done," he said.

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E-mail: jthalman@desnews.com