ST. LOUIS - Mercy was invited to testify at the U.S. House Ways & Means Health subcommittee hearing focusing on modernizing American health care. Dr. Jay Carlson, Mercy medical director of oncology, Mercy Research clinical chair and a founding member of Mercy's Center for Precision Medicine represented Mercy in Washington, D.C. on Feb. 11, 2025.
The focus of the hearing was to examine ways to empower workers and families to seek healthy options and incentivize lifestyle choices. In addition, another major theme was the power of early detection screening tests to identify chronic disease, like cancer, before they progress and become costlier and more life-threatening to patients.
Read his full witness statement below or watch the full hearing here.
Witness Statement 2/11/2025
Name: Jay Carlson, DO, MS
Position: Medical Director for Oncology, Clinical Chair of Mercy Research, and founding member of Mercy’s Center for Precision Medicine.
I want to thank Chairman Buchanan, Ranking Member Doggett, and distinguished members of this committee, for the opportunity to be here today. My name is Jay Carlson, DO, MS. I am a gynecologic oncologist and currently serve at St. Louis-based Mercy health system as the medical director for the Oncology service line and the clinical chair of Mercy Research. I am also a founding member of Mercy’s Center for Precision Medicine or CPM.
Mercy is the 15th largest health systems in the US. It is a community-based system primarily in Missouri with hospitals and clinics in Illinois, Kansas, Oklahoma, and Arkansas with about 5,000 practicing providers. Mercy serves almost 3.6 million lives in Missouri alone.
It is Mercy’s strategic goal to use the best-in-class genomic testing and artificial intelligence to screen and detect at-risk patients earlier in their disease course. To support its strategic goal, Mercy established its Center for Precision Medicine to serve as the subject matter experts on genomic testing and the implementation of state-of-the-art screening.
One example of our screening initiatives is a screening program that focuses on hereditary cancer risk. This risk is linked to an autosomal dominant mutation, which means that 1st degree relatives may have a 50% risk of inheriting the same mutation. These mutations and their transmission may make a single patients’ problem into a family problem. The significance of this becomes evident when some of these mutations are associated with a 40-80% lifetime risk of cancer. The screening tools for discerning who should be tested are based on the National Comprehensive Cancer Network (NCCN) guidelines for hereditary cancer screening. This test is almost always covered by insurance, if one meets the NCCN criteria. For patients with a harmful mutation (called deleterious), the NCCN has identified heightened screening tests or prophylactic surgeries or medications that can be offered to mitigate, or eliminate, the risk of cancer associated with these mutations. Because of its complicated nature, a lot of health systems do not have a coordinated, system-wide effort for these patients who are at exceedingly high-risk of cancer.
To support this screening effort, Mercy completed website development that gives patients access to a hereditary cancer screening tool that then digitally hands the at-risk patients over to the CPM team. We also send SMS texts to patients that link back to the survey tool, and ultimately the CPM team. The patients identified to have a deleterious mutation are further managed by the CPM team for counseling, additional testing, and coordination of their follow up care before being handed back to the primary care providers.
Mercy has an integrated vendor for genomics assays that has made it much easier for providers to order and track the results of these tests. In the last two years, our oncologists have tripled their utilization of genomic tests to help drive targeted therapy for our oncology patients, rather than just prescribing conventional chemotherapy.
Mercy has also implemented a broad multicancer early detection (MCED) screening test. This committee is experienced with this test and has previously supported its utilization. Therefore, I will not necessarily speak to the assay, but rather speak to our implementation of this screening test. Mercy has hospitals that are close to the Coldwater Creek communities, a well-documented area in north St. Louis County where radioactive waste has been linked to a higher rate of cancer, where this test may be of benefit. We also wanted to offer this to other high-risk groups such as firefighters or veterans. To be successful, we knew the deployment would require provider education and the utilization of the CPM team to facilitate the counseling and ordering.
We had a series of virtual educational meetings with providers to review the science. We developed an extensive patient-facing website for the MCED screening test. A separate intranet educational section was developed for providers. We then leveraged AI algorithms to identify high-risk patients for a targeted outreach campaign. We have been using this process for the last two years and have had approximately 3,000 provider referrals through our EMR and more than 9,000 patient self-referrals through our web interface. About one third ultimately proceeded to testing. Those with a positive test received a virtual same-day peer review with me, and two other providers to formulate the diagnostic plan. For patients treated within our health system, the diagnostic evaluations were navigated by the CPM team and completed in a median of 15 days.
The current approved screening tests have been available for years. They are well engrained into medical training and practice. We believe that the screening tests of the future will be more complicated, and frequently involve a combination of AI and some type of ‘omics’ assay making these clearly different than our historical standards.
As we have already experienced, many providers will be unfamiliar with these potential tests, their science, and the use of predictive algorithms behind them. By engaging the CPM team, we have been able to offer these services as a concierge lift to our providers. The CPM team bridged the knowledge deficit and became the content experts in these areas. The centralized approach and standardized workflow we developed may be a model for other health systems to emulate.
In summary, Mercy continues to explore new tests and services that combine the expanding science of genomic with the new benefits of AI, and deploy them at scale, to aide in the screening and accurate diagnosis, and the targeted treatment to improve the quality and value of the care we provide.
I look forward to your questions.
