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  • The U.S. job market has almost 600,000 openings requesting cybersecurity-related skills. 
  • Employers are struggling to fill these openings due to a general cyber-skill shortage, with many openings remaining vacant each year. 
  • When evaluating prospective information-security candidates, employers should look for certifications as an important measure of excellence and commitment to quality.
  • This article is for business owners looking to hire cybersecurity experts, or for individuals interested in pursuing a cybersecurity career. 

Cybersecurity is one of the most crucial areas for ensuring a business’s success and longevity. With cyberattacks growing in sophistication, it’s essential for business owners to protect their companies by hiring qualified cybersecurity experts to manage this aspect of their business. The best candidates will have a certification in information security and cybersecurity. This guide breaks down the top certifications and other guidance you’ll need to make the right hire for your company. It’s also a great primer for individuals who are embarking on a cybersecurity career.

Best information security and cybersecurity certifications

When evaluating prospective InfoSec candidates, employers frequently look to certification as an important measure of excellence and commitment to quality. We examined five InfoSec certifications we consider to be leaders in the field of information security today.

This year’s list includes entry-level credentials, such as Security+, as well as more advanced certifications, like Certified Ethical Hacker (CEH), Certified Information Systems Security Professional (CISSP), Certified Information Security Manager (CISM) and Certified Information Systems Auditor (CISA). According to CyberSeek, more employers are seeking CISA, CISM and CISSP certification holders than there are credential holders, which makes these credentials a welcome addition to any certification portfolio.

Absent from our list of the top five is SANS GIAC Security Essentials (GSEC). Although this certification is still a very worthy credential, the job board numbers for CISA were so solid that it merited a spot in the top five. Farther down in this guide, we offer some additional certification options because the field of information security is both wide and varied.

1. CEH: Certified Ethical Hacker

The CEH (ANSI) certification is an intermediate-level credential offered by the International Council of E-Commerce Consultants (EC-Council). It’s a must-have for IT professionals who are pursuing careers in white hat hacking and certifies their competence in the five phases of ethical hacking: reconnaissance, enumeration, gaining of access, access maintenance and track covering. 

CEH credential holders possess skills and knowledge of hacking practices in areas such as footprinting and reconnaissance, network scanning, enumeration, system hacking, Trojans, worms and viruses, sniffers, denial-of-service attacks, social engineering, session hijacking, web server hacking, wireless networks and web applications, SQL injection, cryptography, penetration testing, IDS evasion, firewalls and honeypots. CEH V11 provides a remapping of the course to the NIST/NICE framework’s Protect and Defend (PR) job role category, as well as an additional focus on emerging threats in cloud, OT and IT security, such as fileless malware.

To obtain a CEH (ANSI) certification, candidates must pass one exam. A comprehensive five-day CEH training course is recommended, with the test presented at the course’s conclusion. Candidates may self-study for the test but must submit documentation of at least two years of work experience in information security with employer verification. Self-study candidates must also pay an additional $100 application fee. Education may be substituted for experience, but this is evaluated on a case-by-case basis. Candidates who complete any EC-Council-approved training (including with the iClass platform, academic institutions or an accredited training center) do not need to submit an application prior to attempting the exam.

Because technology in the field of hacking changes almost daily, CEH credential holders are required to obtain 120 continuing-education credits for each three-year cycle.

Once a candidate obtains the CEH (ANSI) designation, a logical progression on the EC-Council certification ladder is the CEH (Practical) credential. The CEH (Practical) designation targets the application of CEH skills to real-world security audit challenges and related scenarios. To obtain the credential, candidates must pass a rigorous six-hour practical examination. Conducted on live virtual machines, candidates are presented 20 scenarios with questions designed to validate a candidate’s ability to perform tasks such as vulnerability analysis, identification of threat vectors, web app and system hacking, OS detection, network scanning, packet sniffing, steganography and virus identification. Candidates who pass both the CEH (ANSI) and the CEH (Practical) exams earn the CEH (Master) designation.

CEH facts and figures

Certification name Certified Ethical Hacker (CEH) (ANSI)
Prerequisites and required courses Training is highly recommended. Without formal training, candidates must have at least two years of information security-related experience and an educational background in information security, pay a nonrefundable eligibility application fee of $100 and submit an test eligibility form before purchasing an test voucher.
Number of exams One: 312-50 (ECC Exam)/312-50 (VUE) (125 multiple-choice questions, four hours)
Cost of exam $950 (ECC test voucher) Note: An ECC test voucher allows candidates to test via computer at a location of their choice. Pearson VUE test vouchers allow candidates to test in a Pearson VUE facility and cost $1,199.
URL https://www.eccouncil.org/programs/certified-ethical-hacker-ceh
Self-study materials EC-Council instructor-led courses, computer-based training, online courses and more are available at ECCouncil.org. A CEH skills assessment is also available for credential seekers. Additionally, Udemy offers CEH practice exams. CEH-approved educational materials are available for $850 from EC-Council.

Certified Ethical Hacker (CEH) training

While EC-Council offers both instructor-led and online training for its CEH certification, IT professionals have plenty of other options for self-study materials, including video training, practice exams and books.

Pluralsight currently offers an ethical-hacking learning path geared toward the 312-50 exam. With a monthly subscription, you get access to all of these courses, plus everything else in Pluralsight’s training library. Through Pluralsight’s learning path, students can prepare for all of the domains covered in the CEH exam.  

CyberVista offers a practice test for the CEH 312-50 certification that includes several sets of exam-like questions, custom quizzes, flash cards and more. An test prep subscription for 180 days costs $149 and gives candidates access to online study materials, as well as the ability to download the materials for offline study. Backed by its “pass guarantee,” CyberVista is so confident its practice test will prepare you for the CEH test that the company will refund its practice test costs if you don’t pass.

Did you know?FYI: Besides certifications in information security and cybersecurity, the best IT certifications cover areas such as disaster recovery, virtualization and telecommunications.

2. CISM: Certified Information Security Manager

The CISM certification is a top credential for IT professionals who are responsible for managing, developing and overseeing information security systems in enterprise-level applications or for developing organizational security best practices. The CISM credential was introduced to security professionals in 2003 by the Information Systems Audit and Control Association (ISACA).

ISACA’s organizational goals are specifically geared toward IT professionals who are interested in the highest-quality standards with respect to the auditing, control and security of information systems. The CISM credential targets the needs of IT security professionals with enterprise-level security management responsibilities. Credential holders possess advanced and proven skills in security risk management, program development and management, governance, and incident management and response.

Holders of the CISM credential, which is designed for experienced security professionals, must agree to ISACA’s code of ethics, pass a comprehensive examination, possess at least five years of experience in information security management, comply with the organization’s continuing education policy and submit a written application. Some combinations of education and experience may be substituted for the full experience requirement.

The CISM credential is valid for three years, and credential holders must pay an annual maintenance fee of $45 (ISACA members) or $85 (nonmembers). Credential holders are also required to obtain a minimum of 120 continuing professional education (CPE) credits over the three-year term to maintain the credential. At least 20 CPE credits must be earned every year.

CISM facts and figures

Certification name

Certified Information Security Manager (CISM)

Prerequisites and required courses

To obtain the CISM credential, candidates must do the following:

  1. Pass the CISM exam.
  2. Agree to the ISACA code of professional ethics.
  3. Adhere to ISACA’s CPE policy
  4. Possess a minimum of five years of information security work experience in described job practice analysis areas. Experience must be verifiable and obtained in the 10-year period prior to the application date or within five years of test passage. There are some exceptions to this requirement depending on the current credentials held.
  5. Apply for CISM certification. (The processing fee is $50.) The credential must be obtained within five years of test passage.

Number of exams

One: 150 questions, four hours

Cost of exam

Exam fees: $575 (members), $760 (nonmembers)

Exam fees are nontransferable and nonrefundable.



Self-study materials

Training and study materials in various languages, information on job practice areas, primary references, publications, articles, the ISACA Journal, review courses, an test prep community, terminology lists, a glossary and more are available at ISACA.org. Additionally, Udemy offers comprehensive training for the certification exam.

Other ISACA certification program elements

In addition to CISM, ISACA offers numerous certifications for those interested in information security and best practices. Other credentials worth considering include the following:

  • Certified Information Systems Auditor (CISA)
  • Certified in the Governance of Enterprise IT (CGEIT)
  • Certified in Risk and Information Systems Control (CRISC)

The CISA designation was created for professionals working with information systems auditing, control or security and is popular enough with employers to earn it a place on the leaderboard. The CGEIT credential targets IT professionals working in enterprise IT management, governance, strategic alignment, value delivery, and risk and resource performance management. IT professionals who are seeking careers in all aspects of risk management will find that the CRISC credential nicely meets their needs.

Certified Information Security Manager (CISM) training

Pluralsight offers a CISM learning path containing five courses and 17 hours of instruction. The courses cover the domains addressed in the exam, but the learning path is aimed at the CISM job practice areas. 

CyberVista offers a CISM online training course in both live and on-demand formats. The course includes more than 16 hours of training videos, supplementary lessons, custom quizzes, practice test questions and access to experts through the instructor. As with other CyberVista courses, the CISM training course comes with a “pass guarantee.” 

Did you know?Did you know?: According to CyberSeek, there are enough workers to fill only 68% of the cybersecurity job openings in the U.S. A cybersecurity certification is an important way to demonstrate the knowledge and ability to succeed in these job roles.

3. CompTIA Security+

CompTIA’s Security+ is a well-respected, vendor-neutral security certification. Security+ credential holders are recognized as possessing superior technical skills, broad knowledge and expertise in multiple security-related disciplines.

Although Security+ is an entry-level certification, the ideal candidates possess at least two years of experience working in network security and should consider first obtaining the Network+ certification. IT pros who obtain this certification have expertise in areas such as threat management, cryptography, identity management, security systems, security risk identification and mitigation, network access control, and security infrastructure. The CompTIA Security+ credential is approved by the U.S. Department of Defense to meet Directive 8140/8570.01-M requirements. In addition, the Security+ credential complies with the standards for ISO 17024.

The Security+ credential requires a single exam, currently priced at $381. (Discounts may apply to employees of CompTIA member companies and full-time students.) Training is available but not required.

IT professionals who earned the Security+ certification prior to Jan. 1, 2011, remain certified for life. Those who certify after that date must renew the certification every three years to stay current. To renew, candidates must obtain 50 continuing-education units (CEUs) or complete the CertMaster CE online course prior to the expiration of the three-year period. CEUs can be obtained by engaging in activities such as teaching, blogging, publishing articles or whitepapers, and participating in professional conferences and similar activities.

CompTIA Security+ facts and figures

Certification name

CompTIA Security+

Prerequisites and required courses

None. CompTIA recommends at least two years of experience in IT administration (with a security focus) and the Network+ credential before the Security+ exam. Udemy offers a complete and comprehensive course for the certification.

Number of exams

One: SY0-601 (maximum of 90 questions, 90 minutes to complete; 750 on a scale of 100-900 required to pass)

Cost of exam

$381 (discounts may apply; search for “SY0-601 voucher”)



Self-study materials

Exam objectives, sample questions, the CertMaster online training tool, training kits, computer-based training and a comprehensive study guide are available at CompTIA.org.

CompTIA Security+ training

You’ll find several companies offering online training, instructor-led and self-study courses, practice exams and books to help you prepare for and pass the Security+ exam.

Pluralsight offers a Security+ learning path as a part of its monthly subscription plan for the latest SY0-601 exam. Split into six sections, the training series is more than 24 hours long and covers attacks, threats and vulnerabilities; architecture and design; implementation of secure solutions; operations and incident response; and governance, risk and compliance.

CyberVista offers a Security+ practice test so you can test your security knowledge before attempting the SY0-601 exam. The test comes with a 180-day access period and includes multiple sets of test questions, key concept flash cards, access to InstructorLink experts, a performance tracker and more. As with CyberVista’s other offerings, this practice test comes with a “pass guarantee.”

4. CISSP: Certified Information Systems Security Professional

CISSP is an advanced-level certification for IT pros who are serious about careers in information security. Offered by the International Information Systems Security Certification Consortium, known as (ISC)2 (pronounced “ISC squared”), this vendor-neutral credential is recognized worldwide for its standards of excellence.

CISSP credential holders are decision-makers who possess the expert knowledge and technical skills necessary to develop, guide and manage security standards, policies and procedures within their organizations. The CISSP certification continues to be highly sought after by IT professionals and is well recognized by IT organizations. It is a regular fixture on most-wanted and must-have security certification surveys.

CISSP is designed for experienced security professionals. A minimum of five years of experience in at least two of (ISC)2’s eight common body of knowledge (CBK) domains, or four years of experience in at least two of (ISC)2’s CBK domains and a college degree or an approved credential, is required for this certification. The CBK domains are security and risk management, asset security, security architecture and engineering, communications and network security, identity and access management, security assessment and testing, security operations, and software development security.

(ISC)2 also offers three CISSP concentrations targeting specific areas of interest in IT security:

  • Architecture (CISSP-ISSAP)
  • Engineering (CISSP-ISSEP)
  • Management (CISSP-ISSMP)

Each CISSP concentration test is $599, and credential seekers must currently possess a valid CISSP.

An annual fee of $125 is required to maintain the CISSP credential. Recertification is required every three years. To recertify, candidates must earn 40 CPE credits each year, for a total of 120 CPE credits within the three-year cycle.

CISSP facts and figures 

Certification name

Certified Information Systems Security Professional (CISSP) 

Optional CISSP concentrations:  

  • CISSP Architecture (CISSP-ISSAP)
  • CISSP Engineering (CISSP-ISSEP)
  • CISSP Management (CISSP-ISSMP)

Prerequisites and required courses

At least five years of paid, full-time experience in at least two of the eight (ISC)2 domains or four years of paid, full-time experience in at least two of the eight (ISC)2 domains and a college degree or an approved credential are required. Candidates must also do the following:

  • Agree to the (ISC)2 code of ethics.
  • Submit the CISSP application.
  • Complete the endorsement process.

Number of exams

One for CISSP (English CAT exam: 100-150 questions, three hours to complete; non-English exam: 250 questions, six hours) 

One for each concentration area

Cost of exam

CISSP is $749; each CISSP concentration is $599.



Self-study materials

Training materials include instructor-led, live online, on-demand and private training. There is an test outline available for review, as well as study guides, a study app, interactive flash cards and practice tests.

Certified Information Systems Security Professional (CISSP) training

Given the popularity of the CISSP certification, there is no shortage of available training options. These include classroom-based training offered by (ISC)2, as well as online video courses, practice exams and books from third-party companies.

Pluralsight’s CISSP learning path includes 12 courses and 25 hours of e-learning covering the security concepts required for the certification exam. Available for a low monthly fee, the CISSP courses are part of a subscription plan that gives IT professionals access to Pluralsight’s complete library of video training courses.

When you’re ready to test your security knowledge, you can take a simulated test that mimics the format and content of the real CISSP exam. Udemy offers CISSP practice questions to help you prepare for this challenging exam.

5. CISA: Certified Information Systems Auditor

ISACA’s globally recognized CISA certification is the gold standard for IT workers seeking to practice in information security, audit control and assurance. Ideal candidates can identify and assess organizational threats and vulnerabilities, assess compliance, and provide guidance and organizational security controls. CISA-certified professionals demonstrate knowledge and skill across the CISA job practice areas of auditing, governance and management, acquisition, development and implementation, maintenance and service management, and asset protection.

To earn the CISA certification, candidates must pass one exam, submit an application, agree to the code of professional ethics, agree to the CPE requirements and agree to the organization’s information systems auditing standards. In addition, candidates must possess at least five years of experience working with information systems. Some substitutions for education and experience with auditing are permitted.

To maintain the CISA certification, candidates must earn 120 CPE credits over a three-year period, with a minimum of 20 CPE credits earned annually. Candidates must also pay an annual maintenance fee ($45 for members; $85 for nonmembers).

CISA facts and figures

Certification name

Certified Information Systems Auditor (CISA)

Prerequisites and required courses

To obtain the CISA credential, candidates must do the following:

  1. Pass the CISA exam.
  2. Agree to the ISACA code of professional ethics.
  3. Adhere to ISACA’s CPE policy.
  4. Agree to the information auditing standards.
  5. Possess a minimum of five years of information systems auditing, control or security work in described job practice analysis areas. Experience must be verifiable and obtained in the 10-year period prior to the application date or within five years after the test is passed. There are some exceptions to this requirement depending on the current credentials held.
  6. Apply for CISA certification. (The processing fee is $50.) The credential must be obtained within five years of test passage.

Number of exams

One: 150 questions, four hours

Cost of exam

$575 (members); $760 (nonmembers)



Self-study materials

ISACA offers a variety of training options, including virtual instructor-led courses, online and on-demand training, review manuals and question databases. Numerous books and self-study materials are also available on Amazon.

Certified Information Systems Auditor (CISA) training

Training opportunities for the CISA certification are plentiful. Udemy offers more than 160 CISA-related courses, lectures, practice exams, question sets and more. On Pluralsight, you’ll find 12 courses with 27 hours of information systems auditor training covering all CISA job practice domains for the CISA job practice areas.

Beyond the top 5: More cybersecurity certifications

In addition to these must-have credentials, many other certifications are available to fit the career needs of any IT professional interested in information security. Business owners should consider employing workers with these credentials as well.

  • The SANS GIAC Security Essentials (GSEC) certification remains an excellent entry-level credential for IT professionals seeking to demonstrate that they not only understand information security terminology and concepts but also possess the skills and technical expertise necessary to occupy “hands-on” security roles.
  • If you find incident response and investigation intriguing, check out the Logical Operations CyberSec First Responder (CFR) certification. This ANSI-accredited and U.S. DoD-8570-compliant credential recognizes security professionals who can design secure IT environments, perform threat analysis, and respond appropriately and effectively to cyberattacks. Logical Operations also offers other certifications, including Master Mobile Application Developer (MMAD), Certified Virtualization Professional (CVP), Cyber Secure Coder and CloudMASTER.
  • The associate-level Cisco Certified CyberOps Associate certification is aimed at analysts in security operations centers at large companies and organizations. Candidates who qualify through Cisco’s global scholarship program may receive free training, mentoring and testing to help them achieve a range of entry-level to expert certifications that the company offers. CompTIA Cybersecurity Analyst (CySA+), which launched in 2017, is a vendor-neutral certification designed for professionals with three to four years of security and behavioral analytics experience.
  • The Identity Management Institute offers several credentials for identity and access management, data protection, identity protection, identity governance and more. The International Association of Privacy Professionals (IAPP), which focuses on privacy, has a small but growing number of certifications as well.
  • The SECO-Institute, in cooperation with the Security Academy Netherlands and APMG, is behind the Cyber Security & Governance Certification Program; SECO-Institute certifications aren’t well known in the United States, but their popularity is growing. 
  • It also may be worth your time to browse the Chartered Institute of Information Security accreditations, the U.K. equivalent of the U.S. DoD 8570 certifications and the corresponding 8140 framework.

Also, consider these five entry-level cybersecurity certifications for more options.

TipTip: Before you decide to purchase training for a certification or an test voucher, see if your employer will cover the cost. Employers may cover all or part of the cost if you have a continuing education or training allowance, or if the certification is in line with your current or potential job duties.

Information security and cybersecurity jobs

According to CyberSeek, the number of cybersecurity job openings in the U.S. stands at almost 598,000, with about 1.05 million cybersecurity professionals employed in today’s workforce. Projections continue to be robust: The U.S. Bureau of Labor Statistics expects 33% growth in information security analyst positions between 2020 and 2030; in comparison, the average rate of growth for all occupations is about 8%.

Security-related job roles include information security specialist, security analyst, network security administrator, system administrator (with security as a responsibility) and security engineer, as well as specialized roles, like malware engineer, intrusion analyst and penetration tester.

Average salaries for information security certified and security engineers – two of the most common job roles – vary depending on the source. For example, SimplyHired reports about $74,000 for specialist positions, whereas Glassdoor‘s national average is about $108,000. For security engineers, SimplyHired reports almost $112,000, while Glassdoor’s average is more than $111,000, with salaries on the high end reported at $261,000. Note that these numbers frequently change as the sources regularly update their data. [Meet the man who kept Microsoft safe and secure for more than a decade.]

Our informal job board survey from April 2022 reports the number of job posts nationwide in which our featured certifications were mentioned on a given day. This should supply you an idea of the relative popularity of each certification.

Job board search results (in alphabetical order by cybersecurity certification)




LinkedIn Jobs



CEH (EC-Council)
























Security+ (CompTIA)






Did you know?Did you know?: Cybersecurity matters even when you’re traveling. Find out how to keep your computer secure when you’re on the road for business or pleasure.

The importance of hiring information security and cybersecurity professionals

According to Risk Based Security‘s 2021 Year End Data Breach Quickview Report, there were 4,145 publicly disclosed breaches throughout 2021, containing over 22 billion records. This is the second-highest number of breached records, after an all-time high the year before. The U.S. was particularly affected, with the number of breaches increasing 10% compared with the previous year. More than 80% of the records exposed throughout 2021 were due to human error, highlighting an ever-increasing need for cybersecurity education, as well as for highly skilled and trained cybersecurity professionals. [Learn how to recover from a data breach.]

If you’re serious about advancing your career in the IT field and are interested in specializing in security, certification is a great choice. It’s an effective way to validate your skills and show a current or prospective employer that you’re qualified and properly trained. If you’re a business owner, hiring certified professionals and skilled IT managers can help prevent cyberattacks and provide confidence that your company’s security is in the right hands. In the meantime, review our quick cybersecurity tips to Excellerate your company’s protection.

Jeremy Bender contributed to the writing and research in this article.

Thu, 01 Dec 2022 10:00:00 -0600 en text/html https://www.businessnewsdaily.com/10708-information-security-certifications.html
Killexams : Apollo Medical Holdings, Inc. Receives NCQA's HEDIS Health Plan Measure Certification for Measurement Year 2022

ALHAMBRA, Calif., Nov. 17, 2022 /PRNewswire/ -- Apollo Medical Holdings, Inc. ("ApolloMed," and together with its subsidiaries and affiliated entities, the "Company") (NASDAQ: AMEH), a leading physician-centric, technology-powered healthcare company focused on enabling providers in the successful delivery of value-based care, today announced that ApolloMed received certification from the National Committee for Quality Assurance ("NCQA") for the Healthcare Effectiveness Data and Information Set ("HEDIS®"), following the development of its new HEDIS engine that identifies HEDIS gaps in care.

ameh logo (PRNewsfoto/Apollo Medical Holdings, Inc.)

ApolloMed was certified by the NCQA HEDIS Health Plan Measure Certification Program for the measurement year 2022. This year's certified measures include Hemoglobin A1c Control for Patients with Diabetes (HBD), Blood Pressure Control for Patients with Diabetes (BPD), Kidney Health Evaluation for Patients with Diabetes (KED), Lead Screening in Children (LSC), and Child and Adolescent Well-Care Visits (WCV).

NCQA (www.ncqa.org) is an independent, non-profit organization that accredits and certifies a wide range of healthcare organizations. In addition, NCQA manages the evolution of HEDIS, the healthcare quality measurement tool used by more than 90 percent of health plans in the United States, covering 200 million people.

This certification allows ApolloMed to provide services that align with the industry's most rigorous clinical quality measurement processes, resulting in more accurate and timely identification of eligible members and services. Additionally, its new HEDIS engine was designed to increase interpretability and interoperability with other data engines and technologies.

Kevin Buchan, Jr., Ph.D., Director of Analytics of ApolloMed, said, "It was a challenging yet rewarding journey to implement a new HEDIS engine from scratch using various modern technologies to enhance and streamline the user experience. We made this investment to supply our provider partners access to the information that will allow them to better understand how to continue improving upon the high-value care being delivered to their patients."

Yubin Park, Ph.D., Chief Analytics Officer of ApolloMed, stated, "Having received NCQA's certification for the HEDIS measures, we can better align our viewpoints with that of our payers and provider partners. In addition, combined with other data sources, our HEDIS engine will power various data analytics functions, uncovering potential causes for care gaps, such as social determinants of health."

Brandon Sim, Co-CEO of ApolloMed, added, "We are excited to add this new capability to our analytics portfolio. Accurately measuring clinical quality is a necessary building block to delivering high-quality, value-based care. ApolloMed is at the forefront of digitally enabled value-based care. We are one of six NCQA Digital Quality Solutions Pilot participants, and the learnings from the pilot put our certified HEDIS engine in a unique position that complements the new digital measure framework. We plan to share our digitally-enabled value-based care journey with many other provider partners, particularly those just beginning their transition to value-based care delivery."

HEDIS® is a registered trademark of NCQA. NCQA HEDIS Health Plan Measure Certification Program™ is a trademark of NCQA.

About Apollo Medical Holdings, Inc.

ApolloMed is a leading physician-centric, technology-powered, risk-bearing healthcare management company. Leveraging its proprietary end-to-end technology solutions, ApolloMed operates an integrated healthcare delivery platform that enables providers to successfully participate in value-based care arrangements, thus empowering them to deliver high quality care to patients in a cost-effective manner.

Headquartered in Alhambra, California, ApolloMed's subsidiaries and affiliates include management services organizations (MSOs), affiliated independent practice associations (IPAs), and entities participating in the Centers for Medicare & Medicaid Services Innovation Center (CMMI) innovation models. For more information, please visit www.apollomed.net.

Forward Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, such as statements about the Company's acquisition strategy, continued growth, operational focus and strategic growth plans. Forward-looking statements reflect current views with respect to future events and financial performance and therefore cannot be guaranteed. Such statements are based on the current expectations and certain assumptions of the Company's management, and some or all of such expectations and assumptions may not materialize or may vary significantly from actual results. Actual results may also vary materially from forward-looking statements due to risks, uncertainties and other factors, known and unknown, including the risk factors described from time to time in the Company's reports to the Securities and Exchange Commission ("SEC"), including, without limitation the risk factors discussed in the Company's Annual Report on Form 10-K for the year ended December 31, 2021, and any subsequent quarterly reports on Form 10-Q.


Investor Relations
(626) 943-6491 

Carolyne Sohn, The Equity Group
(408) 538-4577


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SOURCE Apollo Medical Holdings, Inc.

Tue, 29 Nov 2022 00:24:00 -0600 en-US text/html https://www.yahoo.com/lifestyle/apollo-medical-holdings-inc-receives-130500770.html
Killexams : Best Database Certifications for 2022
  • Database technology is crucial in multiple applications and computing tasks, and certifications help demonstrate job readiness and core competencies. 
  • Before pursuing a database platform certification, you should have a solid background in relational database management systems and the SQL language. 
  • Valuable certifications are typically tied to specific technology companies and their platforms, such as IBM, Microsoft, Oracle and SAP.
  • This article is for IT professionals considering database certifications to further their careers. 

While database platforms have come and gone through the decades, database technology is still critical for multiple applications and computing tasks. IT professionals often seek database certifications to demonstrate their knowledge and expertise as they navigate their career paths and pursue professional growth. 

While database certifications may not be as bleeding edge as Google cloud certifications, cybersecurity certifications, storage certifications or digital forensics certifications, database professionals at all levels possess in-demand career skills — and a plethora of database-related jobs are waiting to be filled.

We’ll look at some of the most in-demand certifications for database administrators, database developers and anyone else who works with databases.

What to know about database roles and certifications

To get a better grasp of available database certifications, it’s helpful to group these certs around job responsibilities. This reflects the maturity of database technology and its integration into most aspects of commercial, scientific and academic computing. As you read about the various database certification programs, keep these job roles in mind: 

  • Database administrator (DBA). A DBA is responsible for installing, configuring and maintaining a database management system (DBMS). The job is often tied to a specific platform, such as Oracle, MySQL, DB2 or SQL Server.
  • Database developer. A database developer works with generic and proprietary application programming interfaces (APIs) to build applications that interact with a DBMS. Like DBA roles, database developer positions are also often platform-specific.
  • Database designer or database architect. A database designer or architect researches data requirements for specific applications or users and designs database structures and application capabilities to match.
  • Data analyst or data scientist. A data analyst or scientist is responsible for analyzing data from multiple disparate sources to discover previously hidden insights, determine the meaning behind data, and make business-specific recommendations.
  • Data mining or business intelligence (BI) specialist. A data mining or BI specialist focuses on dissecting, analyzing and reporting important data streams, such as customer, supply chain and transaction data and histories.
  • Data warehousing specialist. A data warehousing specialist assembles and analyzes data from multiple operational systems (such as orders, transactions, supply chain information and customer data) to establish data history, analyze trends, generate reports and forecasts, and support general ad hoc queries. 

These database job roles highlight two critical issues to consider if you want to be a database professional:

  1. You need a solid general background. First, a background in relational database management systems, including an understanding of Structured Query Language (SQL), is a fundamental prerequisite for database professionals of all stripes. 
  2. There’s a focus on proprietary technologies. Second, although various efforts to standardize database technology exist, much of the whiz-bang capability that databases and database applications deliver comes from proprietary, vendor-specific technologies. Serious, heavy-duty database skills and knowledge are tied to specific platforms, including various Oracle products (such as the open-source MySQL environment and Oracle itself,) Microsoft SQL Server and IBM DB2. Most of these certifications relate directly to those enormously popular platforms. 

Did you know?Did you know? NoSQL databases — called “not only SQL” or “non-relational” databases — are increasingly used in big data applications associated with some of the best big data certifications for data scientists, data mining and warehousing, and business intelligence.

Best database certifications

Here are details on our five best database certification picks for 2022.

1. IBM Certified Database Administrator — DB2 12

IBM is one of the leaders in the worldwide database market by any objective measure. The company’s database portfolio includes industry-standard DB2, as well as the following:

  • IBM Compose
  • Information Management System (IMS)
  • Informix
  • Cloudant
  • IBM Open Platform with Apache Hadoop

IBM also has a long-standing and well-populated IT certification program that has been around for more than 30 years and encompasses hundreds of individual credentials. 

After redesigning its certification programs and categories, IBM now has a primary data-centric certification category called IBM Data and AI. It includes a range of database credentials: 

  • Database Associate
  • Database Administrator
  • System Administrator
  • Application Developer 

IBM’s is a big and complex certification space, but one where particular platform allegiances are likely to guide readers toward the handful of items most relevant to their interests and needs. 

Database professionals who support DB2 (or aspire to) on IBM’s z/OS should check out the IBM Associate Certified DBA — Db2 12 certification. It’s an entry-level test that addresses routine planning, working with SQL and XML, security, operations, data concurrency, application design, and concepts around database objects.

This certification requires candidates to pass one exam. Pre-exam training and familiarity with concepts, or hands-on experience, are recommended but not required. 

IBM Certified Database Administrator — DB2 facts and figures

Certification name

IBM Certified Database Administrator — Db2 12 (z/OS)

Prerequisites and required courses

None required; recommended courses are available.

Number of exams

One: C1000-122: Db2 12 for z/OS DBA Fundamentals (63 questions, 90 minutes)

Cost per exam

$200 (or local currency equivalent) per exam. Sign up for exams at Pearson VUE.



Self-study materials

The certification page includes self-study materials, including a study guide and a learning path. 

Did you know? IBM’s certification offerings are among the best system administrator certifications IT professionals can achieve.

2. Microsoft Azure

Microsoft Azure offers a broad range of tools and add-ons for business intelligence. Azure is a cloud computing platform for application management and Microsoft-managed data centers. Microsoft certifications include various Azure offerings based on job role and experience level.

Microsoft’s certification program is role-centric, centered on the skills you need to succeed in specific technology jobs. Because Azure has such a broad scope, Azure certifications span multiple job roles. However, specific certifications exist for the following positions:

  • Data Analysts
  • Data Engineers
  • Data Scientists
  • Database Administrators 

There are also certifications for learners at different experience levels. 

For those looking to take their Azure knowledge to the next level, the Microsoft Certified: Azure Data Fundamentals certification is the perfect place to start. This certification is for beginner database administrators interested in using Azure and mastering data in the cloud. It offers foundational knowledge of core concepts while reinforcing concepts for later use in other Azure role-based certifications, such as those listed below: 

  • Azure Database Administrator Associate
  • Azure Data Engineer Associate
  • Data Analyst Associate 

Azure Data Fundamentals certification facts and figures

Certification name

Microsoft Certified: Azure Data Fundamentals

Prerequisites and required courses 

This certification does not have any prerequisites. However, for absolute beginners, Microsoft offers an Azure Fundamentals certification. 

Number of exams

One exam, DP-900, which is administered via Pearson VUE or Certiport.

Cost per exam

The test costs $99 in the United States, though the cost changes based on where it is proctored. 



Self-study materials

Microsoft offers one of the world’s largest and best-known IT certification programs, so the test is well supported with books, study guides, study groups, practice questions and other materials. Microsoft also offers a free online learning path.

3. Oracle Certified Professional, MySQL 5.7 Database Administrator 

Oracle runs its certifications under the auspices of Oracle University. The Oracle Database Certifications page lists separate tracks depending on job role and product. MySQL is perhaps the leading open-source relational database management system (RDBMS). Since acquiring Sun Microsystems in 2010 (which had previously acquired MySQL AB), Oracle has rolled out a paid version of MySQL and developed certifications to support the product. 

If you’re interested in pursuing an Oracle MySQL certification, you can choose between MySQL Database Administration and MySQL Developer. 

The Oracle Certified Professional, MySQL 5.7 Database Administrator (OCP) credential recognizes professionals who can accomplish the following tasks:

  • Install, optimize and monitor MySQL Server.
  • Configure replication.
  • Apply security.
  • Schedule and validate database backups. 

The certification requires candidates to pass a single test (the same test can be taken to upgrade a prior certification). Oracle recommends training and on-the-job experience before taking the exam.

Oracle Certified Professional, MySQL 5.7 Database Administrator facts and figures

Did you know? According to Oracle, approximately 1.8 million Oracle Certified professionals globally hold certifications to advance their networking careers and professions to validate their IT expertise. 

4. Oracle Database SQL Certified Associate Certification

For individuals interested in working in the Oracle environment who have the necessary experience to become a database administrator, Oracle’s Database SQL Certified Associate Certification is another top Oracle certification and an excellent starting point. This test encompasses an understanding of fundamental SQL concepts that individuals must grasp for database projects. 

By earning the certification, individuals demonstrate that they have a range of knowledge in core SQL concepts:

  • Familiarity with queries, data modeling, and normalization
  • Strong base understanding of the underlying SQL language
  • An ability to create and manipulate Oracle Database tables 

This certification also requires candidates to pass a single exam. While Oracle does not specify any prerequisites, the company does state candidates should have familiarity working with the command line. 

Oracle Database SQL Certified Associate Certification facts and figures

5. SAP HANA: SAP Certified Technology Associate — SAP HANA 2.0 SPS05

SAP SE has an extensive portfolio of business applications and analytics software, including cloud infrastructure, applications and storage. The SAP HANA platform’s foundation is an enterprise-grade relational database management system that can be run as an appliance on-premises or in the cloud. The cloud platform lets customers build and run applications and services based on SAP HANA. 

SAP offers a comprehensive certification program built to support its various platforms and products. We’re featuring the SAP Certified Technology Associate — SAP HANA cert because it aligns closely with other certifications we’ve highlighted and is in high demand among employers, according to job board surveys. 

This certification ensures database professionals can install, manage, monitor, migrate and troubleshoot SAP HANA systems. It covers the following skills:

  • Managing users and authorizations
  • Applying security
  • Ensuring high availability 
  • Effective disaster-recovery techniques 

SAP recommends that certification candidates get hands-on practice through formal training or on-the-job experience before attempting this exam. The SAP Learning Hub is a subscription service that gives certification candidates access to a library of learning materials, including e-learning courses and course handbooks. 

The annual subscription rate for individual users on the Professional certification track is $2,760. This online training program is designed for those who run, support, or implement SAP software solutions. Though this may seem like a steep price for online training, you will likely be able to pass any SAP certification exams you put your mind to by leveraging all the learning resources available to SAP Learning Hub Professional subscribers. 

Typically, SAP certifications achieved on one of the two most latest SAP solutions are considered current and valid. SAP contacts professionals whose certifications are nearing end-of-life status and provides information on maintaining their credentials.

SAP Certified Technology Associate facts and figures

Certification name

SAP Certified Technology Associate — SAP HANA 2.0 SPS05

Prerequisites and required courses    

None required.

Recommended: Hands-on experience and the following courses: 

  • SAP HANA Installation & Operations SPS12 (HA200) 
  • High Availability and Disaster Tolerance Administration SPS05 (HA201)
  • Monitoring and Performance Tools SPS05 (HA215)
  • Database Migration using DMO SPS05 (HA250)

Number of exams

One exam: SAP Certified Technology Associate — SAP HANA 2.0 SPS05, test code C_HANATEC_17 (80 questions, 180 minutes)

Cost per exam




Self-study materials

The certification web page includes a link to sample questions. SAP HANA trade books and certification guides are available on Amazon. The SAP Help Center offers product documentation and a training and certification FAQs page. The SAP Learning Hub (available on a subscription basis) provides access to online learning content.

Tip: To broaden your skill set, consider pursuing the best sales certifications to better sell and implement various IT solutions, including databases.

Beyond the top 5 database certifications

Additional database certification programs can further the careers of IT professionals who work with database management systems. 

While most colleges with computer science programs offer database tracks at the undergraduate, master and Ph.D. levels, well-known vendor-neutral database certifications exist, including the following: 

  • ICCP certifications. The Institute for the Certification of Computing Professionals (ICCP) offers its unique Certified Data Professional and Certified Data Scientist credentials. Learn more about ICCP certifications from the ICCP website.
  • Enterprise DB certifications. EnterpriseDB administers a small but effective certification program with two primary certs: the EDB Certified Associate and the EDB Certified Professional

These are some additional certifications: 

These credentials represent opportunities for database professionals to expand their skill sets — and salaries. However, such niches in the database certification arena are generally only worth pursuing if you already work with these platforms or plan to work for an organization that uses them.

Key takeaway: Pursuing additional database certifications can be helpful for professional development if you already work with these platforms or plan to work with them in the future. 

Job board search results

Before pursuing certifications, consider their popularity with employers to gain a helpful perspective on current database certification demand. Here’s a job board snapshot to supply you an idea of what’s trending.




 LinkedIn Jobs 



IBM Certified Database Administrator — DB2






Azure Data Fundamentals






Oracle Certified Professional, MySQL Database Administrator






Oracle Database SQL Certified Associate Certification












If the sheer number of available database-related positions isn’t enough motivation to pursue a certification, consider average salaries for database administrators. SimplyHired reports $91,949 as the national average in the U.S., ranging from $64,171 to over $131,753. Glassdoor’s reported average is somewhat lower at $84,161, with a top rung for experienced senior DBAs right around $134,000.

Choosing the right certification

Choosing the best IT certifications to enhance your skills and boost your career can be overwhelming, especially as many available certifications are for proprietary technologies. While picking a database certification can feel like locking yourself into a single technology family, it is worth remembering that many database skills are transferable. Additionally, pursuing any certification shows your willingness to learn and demonstrates competence to current and future employers. 

Ultimately, choosing which certification to pursue depends on the technologies you use at work or would like to use at a future employer.

Jeremy Bender contributed to the reporting and writing in this article. 

Mon, 05 Dec 2022 10:00:00 -0600 en text/html https://www.businessnewsdaily.com/10734-database-certifications.html
Killexams : Quality Assurance Using Scanning Acoustic Microscopy

Most automated quality inspection technologies involve machine vision systems and, increasingly, aspects of artificial intelligence-powered software to speed the identification of part defects. But vision-based quality inspection is not the only quality inspection technology available to manufacturers. Another option is scanning acoustic microscopy (SAM).

Also known as ultrasonic non-destructive testing, SAM can identify small defects during manufacturing and analyze the specific root cause of a failure when a device fails in the field.

Hari Polu, president of Okos, a supplier of industrial SAM systems, says the SAM technology makes it possible for manufacturers to move to a higher level of failure analysis because of SAM’s ability to detect defects at a 50-micron level. “With this type of testing, we can inspect materials and discover flaws that were previously undetected,” Polu says.

He adds that a growing number of manufacturers are equipping their R&D and quality assurance labs with SAM, as well as integrating it into production lines for inspection. According to Polu, SAM testing is already the industry standard for inspection of semiconductor components to identify defects such as voids, cracks, and the delamination of different layers within microelectronic devices.

How SAM works

Using SAM, sound is directed from a transducer toward a small point on a target object. To produce an image for quality analyses based on the sound pulses, scans are produced. These scans range from single to multiple layers, which can include up to 50 independent layers. These multi-layer scans allow for “depth-specific information to be extracted and applied to create two-and three-dimensional images without the need for time-consuming tomographic scan procedures or X-ray equipment,” says Polu.

Illustration of SAM. Source: Springeropen.comIllustration of SAM. Source: Springeropen.comThese images are then analyzed by software to detect and characterize flaws such as cracks and voids.

Polu says advanced, phased array SAM systems can detect minute flaws in specialty metals and alloys.

SAM at scale

Even though small manufacturers can use a tabletop SAM system for scan envelopes of more than 300mm with a scan velocity up to 500 mm/s and accuracy and repeatability of +/- 5.0 micron, larger manufacturers typically require higher speed inspection capabilities.

Performing such high-speed inspections with 100% accuracy, as typically required by semiconductor manufacturers, requires automated equipment that can simultaneously inspect several layers, often on multiple channels.

“When high throughput is required for 100% inspection, ultra-fast single or dual gantry scanning systems are utilized along with 128 sensors for phased array scanning,” says Polu. “Multiple transducers can also be used to simultaneously scan for higher throughput.”

Polu noted that an advanced phased array with up to 128 sensors and accompanying software can enable inspection times of five minutes for granular detection of small impurities or defects, compared to the 45-minute inspection time required for a 5 MHz sensor to inspect an 8–10-in. square or disc alloy.

Okos Vue 400-P SAM system. Source: OkosOkos Vue 400-P SAM system. Source: OkosThe Okos software designed to accompany the physical and mechanical SAM scans enable A, B, and C scans, contour following, off-line analysis, and virtual rescanning for composites, metals, and alloys. Polu says this results in highly accurate internal and external inspection for defects and thickness measurement via the inspection software.

“Various software modes can be simple and user friendly, advanced for detailed analysis, or automated for production scanning,” says Polu. “An off-line analysis mode is also available for virtual scanning.”

Okos’ software-driven SAM model enables the company to reduce the costs of SAM testing while still delivering high quality inspection results, thus putting SAM technology “well within reach of even modest testing labs,” he says.

Tue, 29 Nov 2022 03:06:00 -0600 en-us text/html https://www.automationworld.com/factory/sensors/article/22578269/quality-assurance-using-scanning-acoustic-microscopy
Killexams : NCQA Introduces Quality Compass® Exchange Data File

WASHINGTON, Dec. 01, 2022 (GLOBE NEWSWIRE) -- The National Committee for Quality Assurance (NCQA) today announced the inaugural Quality Compass® Exchange Data File, which provides insight into quality improvement and benchmarks through health plan performance data on Healthcare Effectiveness Data and Information Set (HEDIS®) and Pharmacy Quality Alliance measures in the CMS Quality Rating System scoring program. 

The Quality Compass Exchange Data File includes valuable health plan performance data and benchmarks for 264 Exchange plans nationwide. Quality Compass 2022 Exchange includes Exchange/Marketplace data from measurement year 2021. 

"The point of Exchange plans is to make health insurance more accessible to consumers. This comprehensive data source brings insight into the quality and performance of Exchange health plans, so people know what they're getting and where to find good care," said NCQA Assistant Vice President, External Relations, Andy Reynolds. "NCQA exists to Excellerate health care, and Quality Compass Exchange is a key tool to support that goal. This product can also help health plans, government agencies and health IT firms monitor performance and make smart business decisions." 

Quality Compass is an indispensable tool used for conducting competitor analysis, examining quality improvement and benchmarking plan performance.

To learn more about the Quality Compass Exchange Data File, or to submit an order, call NCQA customer support at 888-275-7585 or order online via www.store.ncqa.org/data-and-reports

About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA's website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found on Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.

# # #

Contact Information:
Theresa Masnik

This content was issued through the press release distribution service at Newswire.com.

© 2022 Benzinga.com. Benzinga does not provide investment advice. All rights reserved.

Wed, 30 Nov 2022 23:05:00 -0600 text/html https://www.benzinga.com/pressreleases/22/12/g29923743/ncqa-introduces-quality-compass-exchange-data-file
Killexams : 4 Best Health Insurance Companies for 2023

Choosing a high-quality health insurance plan can help you avoid frustrations when using your medical benefits or getting claims paid.

Remember that quality ratings tell you about policyholder satisfaction, not the level of medical benefits, which is determined by the plan tier.

Health insurance company ratings

Kaiser Permanente is the top-rated health insurance company in the U.S., according to available state data from the National Committee for Quality Assurance (NCQA). Good insurance companies include Blue Cross Blue Shield, UnitedHealthcare, Humana, Aetna and Cigna. The worst-rated health insurance companies are Oscar and Molina.

Overall, these performance ratings can supply you a big-picture snapshot of which health insurance companies are the best, which are in the middle of the pack and which you should avoid.

Kaiser Permanente 4.2 $454
Blue Cross Blue Shield 3.6 $607
UnitedHealthcare 3.5 $546
Humana 3.5 N/A
Aetna (CVS Health) 3.3 $450
Cigna 3.2 $465
Oscar 2.5 $507
Molina 2.0 $499

Find Cheap Health Insurance Policies in Your Area

Because company performance can vary by state, we recommend that those shopping for insurance on HealthCare.gov also compare the star ratings of individual plans offered in their location. This will supply you the best indication of which plans will supply you a good experience.

Note that Humana does not sell individual health insurance plans and only provides health insurance through employer or group plans. This means that you may be able to get a Humana plan through your job, but plans are not available on the health insurance marketplace or directly from Humana.

Find the best health insurance in your state

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Best overall health insurance: Kaiser Permanente

  • Average monthly cost: $454

Kaiser Permanente's consistently high ratings mean you're likely to be satisfied with your health insurance, making it a good choice if plans are available in your area.

  • AM Best financial strength rating: Not rated
  • NAIC complaint index: 76% fewer complaints than the industry average
  • Unique value: Access to Kaiser's medical centers and doctors

Kaiser Permanente offers top-rated individual health insurance options in eight states — California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington — and Washington, D.C.

The company stands out for its good customer service and streamlined access to high-quality medical care. Kaiser Permanente consistently ranks as having the most satisfied customers.

Kaiser health insurance is paired with Kaiser's medical facilities, which can make it easier to manage both your insurance and health services through the same online portal. The downside is that enrollees have a limited provider network. Rather than having access to a wide range of doctors, the plans typically only provide coverage when you go to a Kaiser facility (except during emergencies).

If having access to a wide selection of doctors is important to you, consider Blue Cross Blue Shield, which has the largest network of medical providers in the county.

  • Average monthly cost: $607

Blue Cross Blue Shield stands out for its well-rated plans, large network of providers and wide availability in all 50 states.

  • AM Best financial strength rating: A
  • NAIC complaint index: 43% fewer complaints than the industry average
  • Unique value: BCBS has the largest network of doctors available

Blue Cross Blue Shield (BCBS) has high-quality health insurance and is rated slightly ahead of other major competitors such as UnitedHealthcare and Humana. It also is the most popular health insurance company in the country.

BCBS offers a wide range of plan options and types including HMOs (health maintenance organizations), EPOs (exclusive provider organizations) and PPOs (preferred provider organizations). These choices can help you get the best type of coverage to meet your needs.

The company is also good if you want flexibility with where you get your medical care. The BCBS network includes 90% of the country's doctors and hospitals. Even though the exact network of each plan varies, you'll likely have a wide selection of doctors that are covered.

However, the plans are frequently more expensive than similar coverage from other providers, making Blue Cross not a good choice for those on a tight budget.

Best health insurance for the self-employed: UnitedHealthcare

  • Average monthly cost: $546

UnitedHealthcare offers a variety of insurance options including health, dental and vision, but availability in some states may be limited.

  • AM Best financial strength rating: A+
  • NAIC complaint index: 18% fewer complaints than the industry average
  • Unique value: Digital tools to Excellerate your health care experience

UnitedHealthcare (UHC) offers good-quality health insurance plans, and the company stands out for its comprehensive care, including several add-on benefits and a robust app. For those who are self-employed, this can be a valuable way to streamline coverage, save time and reduce hassle.

Many UHC plans include benefits such as free primary care, low-cost prescriptions and access to wellness programs. And you can add on coverage for dental, vision and disability. Plus, the UHC mobile app lets you have telehealth appointments, estimate procedure costs, compare doctors and manage your plan, making it easier to get the most out of your policy.

However, there are some downsides. UHC health insurance policies can be more expensive than average, and interacting with the company can be frustrating, according to comments on the Better Business Bureau.

Best health insurance for young adults: Aetna

  • Average monthly cost: $450

Aetna's cheaper plans are best for those who would prefer a lower-priced plan that has average quality.

  • AM Best financial strength rating: A
  • NAIC complaint index: 10% more complaints than the industry average
  • Unique value: Cheap rates and rewards program

Aetna's plans have average ratings and lower monthly costs than other providers. This makes Aetna a good deal for those who are young and healthy.

Plus, many plans let you earn rewards or gift cards for healthy activities when you use the Attain by Aetna app on an Apple Watch or Fitbit, helping you save even more.

Plans also provide free or low-cost access to CVS minute clinics, which are located inside CVS or Target retail locations. This can make it easy for policyholders to access in-network care across multiple locations such as a hometown, college town or internship location.

However, these plans may not be a good choice for those who have ongoing medical conditions or who need significant or expensive health procedures. In these cases, you may be more satisfied with a higher-rated company like Kaiser Permanente, Blue Cross Blue Shield or UnitedHealthcare, which have better customer satisfaction and fewer complaints.

Understanding the data behind health insurance ratings

In the health insurance industry, a variety of rating agencies evaluate health insurance companies every year based on factors that include financial strength, customer reviews and policyholder complaints. You can use these metrics to evaluate companies and choose the best insurance for you. The most common third-party ratings for insurance companies include:

  • NCQA health insurance plan ratings: NCQA's overall performance rankings of 0 to 5 combine measurements of consumer satisfaction, clinical measures such as preventive care and quality scoring from the NCQA accreditation process.
  • NAIC complaint index: The National Association of Insurance Commissioners (NAIC) complaint index calculates the rate of company complaints against the size of each insurer. A complaint index under 1.00 indicates the company receives fewer complaints than expected for its size.
  • AM Best financial strength rating: AM Best is a credit rating agency that gives health insurance companies a financial health score. A++ or "superior" is the top grade available. Usually, any company above A- is in an above-average financial situation.

Checking company ratings and customer evaluations can help you understand what the company values and how it stacks up against its competitors. Then, you can get quotes from these companies to decide which one makes sense for your situation.

How to choose the best health insurance company

When choosing a health insurance company, you should evaluate the costs for both the plan and your medical care, as well as customer reviews.

Policy costs, details and company benefits

The most important factor to consider is whether the insurer offers affordable policies that fit your needs.

The price of a health insurance policy can vary widely by insurer. This is typically because some providers offer additional benefits with their policies, such as online member portals or gym memberships.

Additionally, some policies have a wider provider network, which means your health insurance would be accepted by more doctors and medical facilities. However, policies with a bigger network or those that offer you the ability to see any doctor that you want will almost always come with higher monthly premiums.

Finally, besides the monthly price you pay, you should carefully review the deductibles and copays or coinsurance before choosing a policy. These can vary greatly not only by insurer but also by policy. By selecting the plan with a deductible and coinsurance that fit your needs, you can save yourself money.

Customer reviews

When evaluating insurers, you should also consider the experience of other policyholders as a way to indicate if you'll have problems with the insurance plan. Through metrics like the NAIC complaint index and J.D. Power's customer satisfaction scores, you can better understand how that health insurance company treats its policyholders.

Additionally, you should check reviews about the claims process and the ease with which consumers can get their claims filed. Some companies tend to have cheaper health insurance but will lag significantly in customer service. This is important to consider, as claims processing will be integral to your overall customer experience with the health insurance company.

Frequently asked questions

Which health insurance company is the best?

The best overall health insurance company is Kaiser Permanente because its plans are highly rated and have low prices. In addition, Blue Cross Blue Shield is a good health insurance company that offers more flexibility in its coverage and is widely available.

How do I pick the best health insurance plan?

First, choose a well-rated company that’s operating in your area. Then, compare plans to match the level of medical coverage to the amount of medical care you expect to need. A good rule of thumb is that a Bronze plan is a good choice for someone young and healthy. If you expect to need significant medical care, a Gold-tier plan could help you save money on health care.

Which health insurance company has the highest customer satisfaction?

Kaiser Permanente is almost always ranked as having the highest customer satisfaction, and it especially stands out for having the best Medicare Advantage plans. However, Kaiser Permanente is only available in eight states and Washington, D.C.

Sun, 04 Dec 2022 20:48:00 -0600 Stephanie Guinan en text/html https://www.valuepenguin.com/best-health-insurance-companies
Killexams : ‘Service became so bad that we actually had shouting matches’
Adobe Stock
Delayed repairs, perpetually missed appointments, higher-than-expected fees, even limited knowledge on how to fix an issue: The list of management issues that vex condo owners can run long.

When problems big or small arise in a condo building, a property management company can plan a vital role in fixing them swiftly.

Better yet, they can prevent them from happening in the first place.

But unearthing a good management company can sometimes seem just as hard as finding one’s soulmate.

Delayed repairs, perpetually missed appointments, higher-than-expected fees, even limited knowledge on how to fix an issue: The list of management issues that vex condo owners can run long.

“The current one that we have was actually the only one who was willing to meet us in person,” said Todd Davis, a South End resident who has lived in his Columbus Avenue condo building for 31 years — much of that as a building trustee. “Frankly, many of these companies are too busy to meet, and that really carries forward if they land the contract. If it’s a problem before you start, it’ll be a problem all the way through.”

Davis and his fellow trustees selected Newton-based Green Ocean Property Management six years ago to take over building management duties after the prior manager continually disappointed the building owners. Repair costs would come in thousands of dollars more than expected, and the building would occasionally get billed high fees for simple things like changing a light bulb, Davis said.

“Service became so bad that we actually had shouting matches with our property manager,” he added.

Some of the ire over property management companies could stem from the fact that there is surprisingly little oversight of these firms and their qualifications. In Massachusetts, real estate brokers and sales agents need a license, but a building manager doesn’t.

The website of Green Ocean Property Management even highlights the fact that there are no federal or state regulations requiring these companies to operate with a license; then, the company notes how its leader has a variety of real estate and contractor licenses, as well as education credentials.

Only eight states have some degree of regulation over community association managers: Alaska, California, Connecticut, Florida, Georgia, Illinois, Nevada, and Virginia, according to the Community Associations Institute — a global membership group for property managers.

Connecticut, the only New England locale on the list, calls for building managers to go through a state and national criminal background check, complete a course on community association management, and pass a test with a long and daunting name: the Community Association Managers’ International Certification Board Certified Manager of Community Association examination.

Add up all that ire and lack of regulation, and condo owners can get a little desperate to find a viable way forward. Building trustees in a brownstone where Nadine J. Ezzie, a South End-based lawyer, rented several years ago approached her about taking over property management duties after she started her own business.

“They asked: ‘Have you ever considered adding a property management arm to your business? We would hire you immediately,’” Ezzie said. “I’m not in the business. I am an attorney, but that is so indicative of how starved people are for just quality people that they know can care for their buildings.”

There is a logic behind why the trend has been more toward less regulation in latest years, according to Dawn Bauman, executive director and senior vice president of government and public affairs at the Community Associations Institute. The idea is that various regulations and oversight were providing too many obstacles.

“We are already having an issue with people filling jobs,” Bauman said. “Should we be creating another barrier to entry?”

Licensing programs also tend to look at things like criminal activity, and there has been a push to eliminate that piece of oversight on management companies. Those people have already paid their debt to society, the thinking goes.

If a condo board wants to find a good community association manager, they should instead look for a team with credentials or the right educational background, Bauman said. The CAI and other groups like the Institute of Real Estate Management provide various educational programs and credentials.

The CAI’s credentials range from associate management specialist, which requires two years of direct community association management experience, to a large-scale manager, which requires at least 10 years of management experience. That’s a more effective gauge of qualification than a state-mandated license, Bauman said.

“Licensure is the lowest level competency assurance in that profession,” she added. “If you want to make sure somebody is qualified to be a good manager or a qualified management company, look at their credentials and how they have gone above and beyond. If they have earned a number of credentials and they’re proud and they’re holding those out as a badge, they’re probably going to be good.”

‘We are already having an issue with people filling jobs. Should we be creating another barrier to entry?’

DAWN BAUMAN, Community Associations Institute

Although Massachusetts does not have licensing requirements for building managers, there are steps trustees can take to make sure they are handing responsibility for the property over to the right team. A lot of it boils down to vetting and interviewing potential building managers carefully.

The No. 1 thing a person can do is ask around for references and connect with a company’s existing clients, said Thomas O. Moriarty, a real estate attorney and partner at Moriarty Troyer & Malloy who was president of the Community Associations Institute’s New England Chapter.

“That’s obviously not a regulatory or even an industry check, but if you wanted practical advice about how to find somebody that you believe is going to be competent, that would be the way to do it,” Moriarty said.

Moriarty doesn’t view the lack of state oversight as a big disadvantage.

“Every lawyer in Massachusetts has to pass the bar exam, but we know there are good lawyers and there are bad lawyers in Massachusetts,” he said. “That’s a pretty high barrier to entry from a licensing regulatory perspective, but it still doesn’t tell you whether or not your experience with this lawyer is going to be positive. Just like I would want referrals for community association managers, I would want somebody who’s worked with the lawyer. That’s the practical side of things.”

But it also appears to be a business opportunity for those willing to dive in. Never say never when it comes to the idea of Ezzie launching her own property management company, she said with a laugh.

“It’s probably just a matter of timing,” she added. “The South End is such a special neighborhood. These beautiful, historic homes that we have the privilege of residing in deserve better, deserve to be treated better, and the people that choose to live in them deserve better service as well.”

Send comments to [email protected]. Follow Cameron Sperance on Twitter @camsperance and Address @globehomes.

Wed, 30 Nov 2022 05:38:00 -0600 en-US text/html https://www.boston.com/real-estate/local-news/2022/11/30/condo-property-management-woes/
Killexams : Feds said salmon is safe to eat — but didn't consider Native diets

“The only thing we don’t eat is the bones and the teeth, but everything else is sucked clean,” Sam said, laughing.

Her mother and grandmother taught her that salmon is a gift from the creator, a source of strength and medicine that is first among all foods on the table. They don’t waste it.

“The skin, the brain, the head, the jaw, everything of the salmon,” she said. “Everybody’s gonna have the opportunity to consume that, even if it’s the eyeball.”

Sam is a member of the Confederated Tribes and Bands of the Yakama Nation. They are among several tribes with a deep connection to salmon in the Columbia River Basin, a region that drains parts of the Rocky Mountains of British Columbia, Canada, southward through seven U.S. states into the West’s largest river.

It’s also a region contaminated by more than a century of industrial and agricultural pollution, leaving Sam and others to weigh unknown health risks against sacred practices.

“We just know that if we overconsume a certain amount of it that it might have possible risks,” Sam said as she gutted salmon in the bustling kitchen. “It’s our food. We don’t see it any other way.”

But while tribes have pushed the government to pay closer attention to contamination, that hasn’t happened. Regulators have done so little testing for toxic chemicals in fish that even public health and environmental agencies admit they don’t have enough information to prioritize cleanup efforts or to fully inform the public about human health risks.

So Oregon Public Broadcasting and ProPublica did our own testing, and we found what public health agencies have not: Native tribes in the Columbia River Basin face a disproportionate risk of toxic exposure through their most important food.

OPB and ProPublica purchased 50 salmon from Native fishermen along the Columbia River and paid to have them tested at a certified lab for 13 metals and two classes of chemicals known to be present in the Columbia. We then showed the results to two state health departments, U.S. Environmental Protection Agency officials and tribal fisheries scientists.

The testing showed concentrations of two chemicals in the salmon that the EPA and both Oregon and Washington’s health agencies deem unsafe at the levels consumed by many of the 68,000-plus Native people who are members of nations living in the Columbia River Basin today. Those chemicals are mercury and polychlorinated biphenyls, or PCBs, which after prolonged exposure can damage the immune and reproductive systems and lead to neurodevelopmental disorders.

The general population eats so little fish that agencies do not consider it at risk, which means that government protocols are mostly failing to protect tribal health. In fact, the contaminants pose an unacceptable health risk if salmon is consumed even at just over half the rate commonly reported by tribal members today, according to guidelines from the EPA and Washington Department of Health.

Story continues below data visualization

Contaminants in fish put tribal members at risk

The potential for exposure extends along the West Coast, where hundreds of thousands of people face increased risks of cancer and other health problems just by adhering to the salmon-rich diet their cultures were built upon.

Chinook salmon, like the ones OPB and ProPublica sampled, migrate to sea over the course of their lives, where they pick up contaminants that Northwest waters like the Columbia and other rivers deposit in the ocean. EPA documents obtained under the Freedom of Information Act show that even with minimal data available, agency staff members have flagged the potential for exposure to chemicals in salmon caught not just in the Columbia but also Washington’s Puget Sound, British Columbia’s Skeena and Fraser rivers, and California’s Sacramento and San Joaquin rivers.

Nations entered into treaties with the U.S. government in the mid-1850s, ceding millions of acres but preserving their perpetual right to their “usual and accustomed” fishing areas; the Supreme Court later likened this right to being as important to Native people as the air they breathe.

But time and again, the U.S. has not upheld those treaties. Damming the Columbia River destroyed tribal fishing grounds and, along with habitat loss and overfishing, drove many salmon populations to near-extinction, wiping some out entirely. Previous reporting has shown how the federal government failed in its promises to compensate nations for those losses and in some cases worked against nations’ efforts to restore salmon populations. In addition, the EPA has allowed cleanups to languish, and state regulators have been slow to rein in industrial pollution. That toxic pollution impairs the ability of salmon to swim, feed and reproduce.

Continually poor and declining salmon numbers have prompted the White House to acknowledge an environmental justice crisis in the Columbia River Basin.

The results of our testing for toxic chemicals point to yet another failure.

A toxic mystery

Questions over fish safety go back generations in some tribal families, predating government concerns by decades.

Karlen Yallup remembers tribal elders telling her the water had been clean enough to drink at Celilo Falls, their primary fishing site on the Columbia River. Yallup’s great-great-grandparents, members of the Warm Springs tribe, lived near the falls and would fish there every day.

As the industrial revolution boomed, farming, industry and urban sprawl grew throughout the basin. In 1957, the falls were submerged by water that pooled behind The Dalles Dam — one of 18 built on the Columbia and its main tributary, the Snake River, to turn the river into a shipping channel, irrigate farmland and generate hydroelectricity. By then, pollution from those new industries had dirtied the water.

Tribal elders told Yallup they knew the water was no longer clean enough to drink when they could see changes and hear differences in the way it ran. They also thinking about the health impacts of Hanford, a sprawling nuclear weapons production complex dozens of miles upstream. Hanford became one of dozens of heavily polluted sites across the Columbia basin, considered one of the largest and most expensive toxic cleanups in the world.

Yallup said her elders began to suspect that whatever was getting into the water was getting into the fish. They became “very thinking about the salmon getting the family sick,” she said.

It wasn’t until the 1990s, however, that the government and the broader public drew attention to the risk to people eating those fish.

In 1992, despite two decades of improving water quality under the Clean Water Act, an EPA study found chemicals embedded in carp from the Columbia River. The results alarmed the region’s tribes, which responded by working with the agency to test more fish and survey members about their fish consumption rates.

Those efforts revealed that tribal people, on average, eat six to 11 times more fish than non-tribal members. They also detected more than 92 different contaminants in the fish, some at levels high enough to harm human health.

In the years that followed, EPA staff expressed concerns over toxic contamination in report after report, but little happened in response. The issue officially became an agency priority during the administration of President George W. Bush, but the EPA repeatedly fell short of its goals to clean up toxic sites as responsible parties fought over how much it would cost, who would pay and how quickly it needed to be done.

The agency also never had the money to fulfill its plans for continuous monitoring, said Mary Lou Soscia, the Columbia River coordinator for the EPA, leaving the agency unable to determine whether the river was getting cleaner.

“Nobody wanted to pay attention to toxics,” said Soscia, who has been working on river cleanup since the late 1990s. “But there are small amounts of studies that supply us like those yellow blinking lights. And when tribal people eat so much fish, it’s something we have to be really, really concerned about.”

Finally, Oregon delivered in 2011 what was hailed as a breakthrough moment: It adopted new water-quality standards to protect tribal people’s health. The state vowed to restrict the amount of chemicals released by industrial facilities and wastewater plants so that people could eat over a third of a pound of fish per day without increasing their risk of health problems. That amount of fish was based on a survey of tribal members done in the 1990s.

Other states that share the Columbia River or its tributaries were slow to follow suit. Washington waited a decade to adopt equally protective standards; Idaho and Montana still have not.

But while Oregon was ahead of its neighbors, state regulators took few steps to ensure polluters actually met the state’s new limits. For as many as half the contaminants at issue, the state said it didn’t have the technology to measure whether polluters met the new stricter criteria.

The Oregon Department of Environmental Quality also said it didn’t have the staff to keep pollution permits updated. It let more than 80% of polluters operate with expired permits, meaning they weren’t even being held to new standards.

When asked in September for evidence of how the state’s highly touted standard has actually improved water quality, the DEQ said it “does not have significant amounts of data on the concentration of bioaccumulative pollutants in the Columbia River, and therefore does not have any trend information.”

Jennifer Wigal, DEQ’s water quality administrator, said the standards were implemented not because of pollution but to ensure that tribal diets were represented.

Wigal also said that when companies release harmful contaminants into the river, most are at such low concentrations that they are below the agency’s ability to detect them. Additionally, most of the contamination affecting fish, the DEQ said, comes not from those polluters but from runoff and erosion from industries like agriculture and logging.

But the DEQ also has yet to curtail that source of pollution. Along the Willamette River, which flows through Oregon’s most populated areas and feeds into the Columbia, the EPA determined last year that the state needed to cut mercury pollution from these sources by at least 88% if it was going to meet its standards for protecting human health.

Congress tried to take matters into its own hands, but it fell into the same pattern of bold plans and delayed action. In 2016 it amended the Clean Water Act, the seminal law governing water pollution nationwide, to require the EPA to establish a program dedicated to restoring the Columbia. It took four years and a nudge from the Government Accountability Office for the program to actually begin. That same year, in 2020, an EPA regional staffer found that broad swaths of the river were polluted with toxic chemicals and were below the standards of the Clean Water Act.

In an emailed response to questions, the EPA repeatedly said Congress gave the agency orders to clean up the Columbia but failed to provide the agency with funding to carry out the work. Even after the agency designated the Columbia an EPA priority, finally elevating the river to the same status as other major ecosystems like the Great Lakes and the Gulf of Mexico, it received no additional funding and staff for cleanup or long-term monitoring.

“That needs to happen,” Soscia, the agency’s Columbia River coordinator, said. “It hasn’t happened.”

A disproportionate risk

Had the government followed through on its plans for monitoring, it might have found what OPB and ProPublica’s testing revealed: Contamination was high enough that it would warrant at least one of the state health agencies to recommend eating no more than eight eight-ounce servings of salmon in a month.

For non-tribal people, who on average eat less than those eight monthly servings, the risk is minute. But surveys show members of some nations in the Columbia River Basin on average eat twice as much fish as the agency’s recommended eight monthly servings.

The testing also revealed the potential for increased cancer risks from PCBs and another class of chemicals known as dioxins. Given an average Columbia River tribal diet, according to latest surveys commissioned by the EPA, the risk is as much as five times higher than what the EPA considers sufficiently protective of public health. This means that, based on the news organizations’ samples, roughly 1 of every 20,000 people would be diagnosed with cancer as a result of eating the average tribal diet — about 16 servings of fish each month — over the course of a lifetime.

The harm goes beyond the raw numbers. That’s because the risk is compounded by exposure from other fish and other toxic chemicals, such as pesticides and flame retardants in those same waters, that weren’t included in OPB and ProPublica’s testing because of cost constraints. Those chemicals are known to accumulate in fish. Beyond fish contamination, tribal populations already experience disproportionately high rates of certain cancers.

Public health officials caution that any cancer risks must be weighed against the many health benefits of eating fish, including the potential to lower the risk of heart disease. The Oregon and Washington health departments, like those of many states, do not assess cancer risk when setting public health advisories.

We showed the result of our testing to public health officials in both Washington and Oregon. Both groups said they would be taking further steps to assess salmon and the exposure risk to tribes.

Emerson Christie, a toxicologist with the Washington Department of Health who analyzed the results, said the department will consider whether to issue an official public health advisory based on the news organizations’ findings. “These results do indicate that there’s a potential for a fish advisory,” Christie said.

David Farrer, an Oregon Health Authority toxicologist who also reviewed the results, said the agency would coordinate with state environmental regulators and the Columbia River Inter-Tribal Fish Commission about additional testing or potential advisories.

Public health advisories and cooking guidance are a last-resort attempt to protect people when larger cleanup efforts fall short or don’t happen at all.

These advisories can also be plagued with delays. When nations collected and tested tissue from the Pacific lamprey back in 2009, they found that the culturally important eel-like fish contained dangerous levels of mercury and PCBs. The Oregon Health Authority responded by issuing a consumption warning in October — but the process took 13 years.

And while advisories put constraints on nations’ traditional diets, they don’t help with the larger issue: The waters from which they are eating fish are still contaminated — with no plan to clean them up.

“The long-term solution to this problem isn’t keeping people from eating contaminated fish — it’s keeping fish from being contaminated in the first place,” Aja DeCoteau, executive director of the Columbia River Inter-Tribal Fish Commission, said when the lamprey advisory was issued.

Wilbur Slockish Jr. is a longtime fisherman who serves on the inter-tribal fish commission.

It is wrong, Slockish said, for the government to allow pollution and then, instead of cleaning it up, decide it can tell people not to eat the fish they always have.

“That’s on the back of our people’s health, the health of the land, the health of the water,” he said. “We’re not disposable.”

A fight too big to ignore

Slockish eats a lot of fish.

He relies on stockpiles of jarred, dried or smoked salmon to get him through the winter. He said it’s not uncommon for him to eat more than a pound of salmon or lamprey in one sitting, sometimes multiple times per day.

He’s a direct descendant of the Klickitat nation’s Chief Sla-kish, who signed the Yakama Treaty of 1855, guaranteeing his people’s right to the fish. At that time, studies estimate that, on average, Indigenouspeople in the region ate five to 10 times more fish than they do today. Slockish is not going to stop eating fish because of warnings about chemical contamination.

He doesn’t see the alternatives as any better. Many in his family have struggled with heart disease, diabetes and cancer. He connects it to their being forced away from the river and made to eat government-issued commodity foods full of preservatives.

“All of our foods were medicine,” he said. “Because there were no chemicals.”

Research across the globe has connected the loss of traditional diets with spikes in health problems for Indigenous populations. In one West Coast nation, the Karuk of Northern California, researchers found a direct link between families’ loss of access to salmon and increased prevalence of diabetes and heart disease.

Public health experts agree that wild salmon, wherever it’s caught, remains one of the healthiest sources of protein available, and that chemicals can also contaminate other foods beyond just fish.

Tribal leaders also worry more about their members getting too little fish than too much of it. And because salmon are a primary income source for many tribal fishers, they worry that fears over fish safety will drive away customers.

But for Columbia River tribes, fish are also a cultural fixture, present at every ceremony. They are shared as customary gifts. Babies teethe on lamprey tails. Salmon heads and backbones are boiled into medicinal broths for the sick and elderly.

Tribes up and down the river continue to fight for their right to a traditional diet and to clean fish.

Yallup, from the Warm Springs tribe, decided to become an advocate for salmon after hearing from her grandmothers how much more limited their traditions had become.

She’s on track to graduate in December from Portland’s Lewis & Clark Law School. Yallup chose the law profession to fight for salmon, she said, and to change laws to protect the river from pollution.

“If I had a choice, I would just be a fisherman. I felt the responsibility to have to leave the reservation and have to go to law school,” Yallup said. “It’s such a big fight now. It’s kind of impossible to ignore.”

Earlier this year, nations successfully lobbied for one of their Columbia River fishing sites just east of Portland, known as Bradford Island, to be added to the list of polluted places eligible for cleanup money from the federal Superfund program.

In August, the EPA received $79 million to reduce toxic pollution in the Columbia River as part of President Joe Biden’s Bipartisan Infrastructure Law. It is the most money ever dedicated to reducing Columbia River contamination. It’s also a fraction of what nations and advocates say is needed.

The Yakama Nation is using some of that EPA money to lead a pilot study into the kind of long-term monitoring that has been a recognized need for decades.

Laura Klasner Shira, an environmental engineer for Yakama Nation Fisheries, said the nation put together four federal grants to pay for its pilot study, which is limited to the area around Bonneville Dam, east of Portland. They hope someday it could grow to span nearly the entire length of the Columbia, up to the Canadian border. But it took 10 years to get as far as they are now.

“It’s disappointing that the tribes have to take on this work,” she said, noting that government agencies not only have treaty and legal responsibilities but better funding. “The tribes have been the strongest advocates with the least resources.”

They will sample resident fish, young salmon on their way to the ocean, and adult salmon after they’ve returned.

They have two years to finish the work. After that, funding for their monitoring becomes a question mark.

Oregon Public Broadcasting and ProPublica reporters conducted interviews and listening sessions with tribal leaders, toxicologists and public health experts, many of whom became informal advisers throughout the project. Tribal leaders expressed support and interest in additional fish testing. Based on these conversations, the reporters developed a preliminary methodology to test salmon for toxics in a stretch of the Columbia River. The reporters sent this methodology to the same informal advisers for review.

A reporter purchased 50 salmon from tribal fishers upriver of the Bonneville Dam, in the zone of the river reserved for tribal treaty fishing. The majority of the fish were fall Chinook salmon, with two coho salmon and one steelhead. The fish were caught in late September 2021. With the salmon in hand, a reporter gutted the fish, removed the heads and cut them into pieces so they would fit into five coolers. The fish were placed on ice in five different coolers, with 10 fish of roughly the same size placed in each cooler.

Testing of fish can be done on the whole body of the fish, on a fillet with the skin on or on a fillet with the skin removed. Although many people, particularly in tribal communities, consume the head of the fish, reporters asked the laboratory to test fillets with skin because it was determined to capture the best approximation of what’s most often consumed in tribal diets.

A reporter sent the fish samples to ALS, a certified laboratory, and followed ALS protocols for the collection and delivery of samples. The laboratory combined fish to create five new composite samples, each one with 10 fish. (Creating composite samples enables more fish to be tested without raising laboratory costs.) Then ALS technicians conducted testing to assess levels of 13 metals and two classes of chemicals in each of the five fish samples. In March 2022, ALS sent OPB and ProPublica an analytical report that included the case narrative, chain of custody and testing results, which we again shared with experts and public health officials as we developed a plan to analyze the results.

As a first step, the reporters conducted quality assurance checks on the testing and processed the data. While doing so, the reporters encountered testing limitations that prompted them to make two choices that are standard in both national and international approaches to fish toxics testing:

1. ALS tested for general mercury, yet methylmercury is the form that is most concerning to public health. The EPA and European Food Safety Authority assume 100% of mercury sampled in fish tissue is methylmercury. The reporters adopted the same approach.

2. ALS tested for arsenic, yet inorganic arsenic is the form that is most concerning to public health. The reporters found that there isn’t as much of a cohesive approach toward identifying the proportion of arsenic that is inorganic without directly testing for it. The Idaho Department of Environmental Quality recently launched a sampling effort where researchers found that, on average, about 4% of the arsenic in fish is inorganic. The department’s study is one of the most robust examinations of inorganic arsenic concentrations near the Columbia River. The Oregon Health Authority takes a different approach. David Farrer, a toxicologist with the agency, said they would initially assume 10% of arsenic is inorganic and, if the results signaled the levels could harm human health, they would then reanalyze any leftover sample specifically for inorganic arsenic. If that were not possible, the health department would not use the data at all. Given these uncertainties, OPB and ProPublica chose not to move forward with assessing cancer risk of inorganic arsenic since the news organizations did not specifically test for it.

The reporters then calculated the average concentration of chemicals across each of the wet weight samples. They then assessed how these results compared to EPA, Oregon Health Authority and Washington Department of Health standards.

Of the 13 metals and two classes of chemicals tested, three contaminants surpassed federal and local standards at varying levels of fish consumption: mercury, or methylmercury; polychlorinated biphenyls, or PCBs; and dioxins/furans.

The reporters shared their methodology and findings with experts for review. Toxicologists with the Oregon Health Authority and the Washington Department of Health, as well as former and current EPA scientists, reviewed the results and, in some cases, conducted their own calculations to assess how the testing findings compared to their respective standards. The reporters then met with each of these individuals to talk through the findings, ask and answer questions, and ultimately update their own findings to incorporate feedback. The experts’ feedback was consistent with one another. This process led to the finding that concentrations of mercury (methylmercury) and PCBs would warrant the EPA and at least one state health agency to recommend eating no more than eight 8-ounce servings of salmon in a month. The equation used for these calculations can be found in this Oregon Health Authority report (Page 4) and this Washington Department of Health report (Page 35).

Simultaneously, OPB and ProPublica calculated the estimated cancer risk from consuming salmon with the contaminant levels found through our testing. For each contaminant, a reporter calculated the levels of exposure for multiple scenarios based on how different populations eat, including general population consumption and average and high rates for Columbia River tribes, which were based on consumption surveys. The amount of contamination assumed in this calculation was taken from the 95% upper confidence limit of the test results. Current and former EPA scientists reviewed the methodology and calculations.

To calculate lifetime cancer risk, the dose of a probable carcinogen must be multiplied by a cancer potency factor, which estimates toxicity. Cancer potency factors, also known as slope factors, were sourced from this EPA report. Former and current EPA officials, as well as an epidemiologist, reviewed the calculations and results.

We also factored in the following consideration: Under EPA guidance, when calculating safe levels of exposure to different chemicals, the agency calculates monthly limits to the exact number of meals a person should eat. But it then rounds that down to the nearest multiple of four in an effort to make risk communication easier to follow. For example, if one were to find that the levels of dioxins would warrant that someone only eat five fish per month to avoid excess cancer risks, that would be rounded down to the four fish per month.

Ultimately, this led to the finding that, based on the levels of dioxins in our samples, anything above four 8-ounce servings of these tested fish each month would create an excess cancer risk beyond the EPA’s benchmark of 1 in 100,000. That means of 100,000 people exposed to these levels of contaminants, one of them would develop cancer as a result of the exposure.

Wed, 07 Dec 2022 06:49:00 -0600 en text/html https://crosscut.com/equity/2022/12/feds-said-salmon-safe-eat-didnt-consider-native-diets
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