WASHINGTON -- President Obama said incentives are needed to encourage health care providers to take a team approach and coordinate care in efforts similar to what Carilion Clinic is attempting.

"We think in this debate, over time, we've got to continue to reward more and more folks who are approaching health care in that integrated fashion," Obama said Wednesday during an interview at the White House. "What exactly the mechanisms end up emerging to do that most effectively is still being debated."

The president did not make specific recommendations for changing the incentive formulas.

Obama held a roundtable discussion on health care with reporters from nine newspapers across from the country, including The Roanoke Times, on Wednesday afternoon in the Roosevelt Room of the White House. Other papers at the table included The (Nashville) Tennessean, The Fresno Bee and The (Portland) Oregonian. The forum followed an earlier town hall meeting in Annandale, Va., where the president answered questions on health care reform.

Both are signs of how the administration is reaching out beyond Washington to move the debate on health care reform forward as Obama continues to press for a bill to be completed by the end of the year.

During the town hall meeting, Obama called for shifting huge sums of money from current health care spending to new goals. About two-thirds of the overall new costs "will come from reallocating money that is already being spent in the health care system but isn't being spent wisely," he said.

He restated his pledge to cut $177 billion over the next decade from Medicare Advantage insurance plans. And he noted that doctors, hospitals, corporations and others have pledged to decrease the annual rate of spending growth by 1.5 percent, or $2 trillion over 10 years.

Obama had previously named places such as the Mayo Clinic and other clinic systems as ways to provide the best quality care while lowering costs.

"What I would like to see is what I just mentioned are the mechanisms for reimbursement rewarding quality," he said. "And the advantage of a lot of these systems is they emphasize prevention. They have a team concept when it comes to service delivery."

Three years ago, Roanoke-based Carilion began transforming from a traditional hospital system to an integrated clinic approach similar to Mayo. Carilion officials have said the process of hiring doctors and creating a culture that supports a team approach to medicine will take seven to 10 years.

The president echoed those sentiments Wednesday as a way to reduce unnecessary duplicate medical tests and better manage disease.

While not getting into specifics, Obama said the current system that often pays physicians higher amounts for doing more procedures must change. Instead, he said, he supports a system that pays for outcomes.

"What we have said to doctors, for example, is if we can change our incentive structures so that we are reimbursing for quality not just quantity, then we can free up dollars to reimburse more doctors generally. What we won't be doing is paying for the number of tests you do."

The president also outlined other aspects of health care reform that could have a direct impact on the Roanoke Valley and Southwest Virginia. While calling for more incentives to encourage doctors to collaborate, he also called for increased incentives for primary care physicians. Specifically, he said, more primary care physicians are needed to help treat and prevent disease among people living in rural areas.

"The other thing we have to do, and this applies not just to rural communities, is to figure out how through the Medicare system and other mechanisms we can encourage family physicians, primary care physicians to play a much larger role in the health care delivery system," he said. "We have a huge shortage of primary care physicians."

Supporting rural medicine and primary care physicians is something touted not only by Carilion, but also by the neighboring hospital system HCA Southwest Virginia. The HCA hospitals include those in Pulaski, Montgomery and Alleghany counties. Additionally, part of mission for the Edward Via Virginia College of Osteopathic Medicine in Blacksburg is to train and promote primary care physicians to practice in rural communities.

Addressing concerns that reform could lead to job losses in the health care industry, Obama said he believed reform would be an advantage to businesses.

"Where they are providing quality care at affordable prices, they are going to have more customers because under health care reform more Americans are going to have health insurance and they are going to be looking for the best possible deal," he said.

Later he added that health care reform could provide new economic opportunities in areas of health care information technology and others.

"I think we're going to be in a position where we see more and more efficiencies in the system and that allows for greater innovation, entrepreneurship in the health care industry," he said.

The Associated Press contributed to this report.