Witnesses tell Ways and Means hearing early‑detection tests show promise but raise access and cost questions

Brooks Tingle, chief executive officer of John Hancock, and Jay Carlson, a gynecologic oncologist and clinical chair at Mercy’s research arm, told a House Ways and Means Health Subcommittee hearing that multi‑cancer early detection (MCED) tests and insurer incentive programs can advance prevention and early diagnosis — but questions remain about Medicare reimbursement, access and downstream costs.

Tingle described John Hancock’s decade‑long Vitality wellness program, which uses app‑based incentives and partner discounts to encourage healthier behavior. “We introduced John Hancock Vitality, a program rooted in behavioral science that offers our life insurance customers tools, resources, incentives, and rewards to help improve their long term health,” Tingle said. He said the company began a partnership in 2022 to offer discounted access to the Grail “Galleri” multi‑cancer early detection test to participating customers and that John Hancock intentionally does not take possession of individual customers’ test results to avoid chilling consumer uptake.

Carlson described Mercy Health System’s implementation of MCED and other precision‑medicine tools across its hospitals and clinics. Mercy developed clinician and patient education, a patient‑facing website, and an AI‑driven effort to target higher‑risk cohorts. “We’ve been using this process for 2 years and approximately 3,000 patient provider referrals as well as more than 9,000 self referrals through the website,” Carlson said. He reported that Mercy has recorded 27 MCED positive signals that yielded 22 confirmed cancers and said Mercy provides same‑day virtual review and rapid diagnostic follow‑up for patients who test positive.

Committee members and witnesses highlighted both potential benefits and limitations. Witnesses and members noted that Medicare coverage questions remain: a Medicare reimbursement pathway and a large Medicare clinical trial were described as key steps to wider adoption, and speakers said reimbursement could spur additional private‑sector investment. Carlson said some screening tests of the future will combine omics assays and artificial intelligence and will require provider education and system‑level coordination to deploy safely and effectively.

Panelists also acknowledged possible harms and operational challenges. Carlson and others emphasized counseling patients about the risk of false positives and the need for standardized diagnostic workflows; Mercy said it has seen a small number of false positives and that the company and vendors offer retesting or surveillance at no cost when appropriate. Tingle described concrete incentives John Hancock offers — for example, a healthy food savings program that provides discounts at grocery stores — as part of a prevention strategy that insurers may be uniquely positioned to deliver because of long customer relationships.

The witnesses urged congressional action to clarify Medicare policy and to provide predictable coverage paths for MCED tests so that health systems and payers can scale counseling, diagnostic capacity and quality controls without shifting undue cost or anxiety onto patients.