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BOSTON — Four years after Massachusetts embarked on the nation’s most ambitious health care overhaul, Gov. Deval Patrick and legislative leaders are stepping up efforts to rein in spiraling insurance costs.

Those costs are threatening to undermine the 2006 health care law, which mandated nearly universal health coverage and provided a blueprint for the national health care overhaul pushed by President Barack Obama.

The next big goal, supporters say, is to find a way to slow surging premiums while maintaining or improving the delivery of health care services.

It is a task of mind-boggling complexity requiring cooperation among doctors, hospitals, insurers, regulators, state lawmakers and the administration.

One way to head in that direction, supporters say, is to gradually move away from a system that pays doctors and hospitals for the number and type of tests and procedures they deliver and instead rewards them for maintaining the overall health of their patients.

Getting there might not be easy, given the sometimes competing interests of those involved in the process. Massachusetts already has the highest percentage of insured residents of any state, in large part because of the 2006 law.

“We don’t want to break the system we have, but we want to bring the costs down,” said Senate President Therese Murray, D-Plymouth, who has championed payment overhaul.

Murray said lawmakers are aware of not getting in between patients and their doctors. She hopes to file a bill designed in part to rewrite the way health care is paid for in Massachusetts early in the new two-year session that begins in January. Patrick has also said that slowing the cost of health insurance is a top health care priority for his second term.

Doctors and insurers are urging caution.

“Whatever the process, it needs to be slow; it needs to be studied,” said Dr. Alice Coombs, president of the Massachusetts Medical Society.