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Blog | Alto Pharmacy

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.

Get to know Jake Moffatt, Engineering Manager on the Alto Assistant Team

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.
Below, Jake chats with fellow engineering manager Mike Riess and recruiter Braden Hanlon about the work ahead for Alto Assistant.

I’d love to learn more about your background to get us started. How did you end up in software engineering?

When I was twelve, I started learning to code in QBASIC because I wanted to make video games. Once I wrote my first program, I was hooked! I loved computers and the creative power they gave to anyone willing to invest the time and energy to learn. Since then, I’ve built games, personal tools and projects, desktop software, and a number of apps and services — I love building things. My career has gone back and forth between construction and software engineering, but it’s been firmly in the software industry for the last ten years or so.

My favorite place to be in a company is working on something new that has a big impact or addresses an important problem. In a previous role, I built an app that helped people find roommates in a city where housing is prohibitively expensive. At that same company, I led the team responsible for creating a new vertical that eventually split off into its own company.

The goal of Alto Assistant is to help customers help themselves before reaching out to support. Our first project is introducing a wizard-like support “assistant” (hence the team name!) that guides the customer through a series of questions to narrow down the area of support. We’ve already identified a few tasks the assistant can help customers complete on their own, including making changes to upcoming deliveries or scheduling new orders.

In cases where we can’t help them just yet, our new tool generates data to help us to learn exactly what customers need help with. It’s a top priority to bake analytics into every new feature we build; even though we have years of experience supporting our customers — and we know intuitively which problems they frequently experience — we don’t have conclusive data to draw upon just yet.

We plan to start with a couple of frequent use cases and measure how often customers reach out to us for support. Then, we’ll chip away at the problem until we’ve seen a substantial improvement in the user experience. From there, we’ll move on to the next biggest problem and repeat the cycle. There’s a reason “Chip away it” is an Alto value: It’s the playbook that we’ve used to automate other critical parts of the pharmacy value stream like intake, billing, and fulfillment.

What opportunities are you most excited about?

Support drives much of the cost of every shipment today, so this is a high-impact area for our business. A year from now, it would be a stellar outcome if the Assistant team could reduce the number of issues that customers need support on by half.

We’re also thinking about the user experience beyond the app. We plan to improve the tooling that our care specialists use to provide support as well. We’ve already discussed some promising ideas like creating the concept of a conversation in support communications rather than an infinite stream of messages and building out enriched communications. We also intend to develop a custom tool that can expedite a customer’s prescription when they need their medication ASAP.

The possibilities are many, and it will take a team of determined, passionate, empathetic people to solve these challenging problems. I’m super excited to see what the Assistant team will do together.

Any lessons learned from previous experience that you’re applying to your role at Alto?

There’s always the temptation to tackle everything at once with new business initiatives. My experience leading new verticals at Apartment List and Snapdocs taught me the importance of being laser-focused on one or two key metrics instead of trying to build out a fully-realized product from the beginning. That’s exactly what we’re doing on the Alto Assistant Team with our clear focus on reducing communications per shipment — how often customers reach out for help because they could not find what they needed in our app.

It’s also important to recognize that we won’t have all the answers right out of the gate! I like to think of product development as a three-step sequence: learning, growth, and maintenance. Alto Assistant is so young that we’re very much still in the learning phase. We maintain a tight iteration loop with everything we ship: launch, measure the impact, and use the results to iterate and refine our hypotheses about what our users want. Our final product could be anything from a customer support wizard to an AI chatbot to a ticketing system — we have to rely on our key metric of communications per shipment, experimentation, and user feedback to shape the direction.

What got you excited to join Alto? What would you pass on to an engineer thinking about applying to the company?

I was impressed by the Altoids I met during the interview process. I knew I would be working with people from whom I could learn a lot, like Elnaz, who started as an individual contributor and went on to become Director of Engineering and, now, Alto’s first Head of Strategy & Operations. I was also impressed by the quality of the interview process itself — a good sign that the company was well-organized internally. Finally, the pitch for the role was extremely clear, with already-established key metrics that would directly contribute to the company’s bottom line and help Alto become more profitable.

For engineers, I think Alto is a great place for both technical challenges and career growth. We’re still small enough that every individual gets exposure to a broad portfolio of high-impact projects. It’s also a great environment for learning about how a business works — the Product & Technology organization does a great job of sharing information and presenting problems in a way that gets to the root business problem we’re trying to solve. There’s a clear line between any project a team is working on and a foundational business metric. Most importantly, we’re a company that makes a truly positive impact on our users’ lives.

Interested in learning more about engineering at Alto? Follow us on LinkedIn.

Birth control is essential healthcare, allowing you to prevent pregnancy and take charge of your reproductive health. There are many contraceptive methods to choose from. Learning more about the available options can help you, and in some cases, your partner, make the best decisions for your needs and reproductive goals.

Choosing the Right Birth Control for You | Alto Pharmacy

Read on for an overview of some common birth control methods. Our list focuses on hormonal birth control, which contain synthetic versions of estrogen and progesterone. These two hormones play a significant role in reproduction.

There are other options for contraception that must be used every time you have sex, including condoms and diaphragms. When used correctly, condoms and diaphragms are 98% and 88% effective at preventing pregnancy, respectively.

Permanent birth control is also available in the form of surgical procedures (tubal ligation for women and a vasectomy for men). These procedures must be performed by a healthcare provider. Discuss your options for contraception with your provider.

In addition, there are two options for oral emergency contraception to be taken after unprotected sex: levonorgestrel (Plan B®, Mirena®, Kyleena®) and ulipristal (Ella®). Levonorgestrel is sometimes available without a prescription. Ulipristal is prescription-only.

Like all forms of hormonal birth control, the pill stops ovulation, which is the release of a mature egg from the ovaries during each menstrual cycle. The hormones also thicken cervical mucus, an additional layer of pregnancy prevention that keeps sperm from reaching an egg, should one be released.

There are two types of birth control pills:

Combination pills, or combined oral contraceptives (COCs), contain both estrogen and progestin. (Progestin is a synthetic form of progesterone.) COCs are the more common of the two types.

Progestin-only pills (POPs) contain only progestin.

In both cases, the pills come in a pack and you take one every day.

Many individuals choose the pill for its affordability and effectiveness. However, it must be taken on time every day in order to prevent pregnancy. You may find it helpful to combine taking your birth control with another daily habit such as brushing your teeth, or to set a reminder on your phone. The Alto app has medication management reminders to help you continue with your treatment.

While the pill is 91% effective at preventing pregnancy when taken as prescribed, it does not offer protection against sexually transmitted infections (STIs). If you have an STI or are unsure about a sexual partner’s health history, use condoms every time you have sex to protect your health and your partner’s.

The birth control ring, also referred to as the vaginal ring, consists of a small, flexible ring worn inside of your vagina. It releases hormones, which are absorbed through the vaginal lining, for ongoing pregnancy prevention. Like birth control pills, these hormones prevent ovulation and thicken cervical mucus.

There are two types of birth control rings. NuvaRing® lasts for up to five weeks. It is worn continuously and typically replaced about once a month. It may also be used to skip your period.

An Annovera® ring lasts for a year. You wear it in your vagina for 21 days, take it out for seven days, and then put it back in your vagina to restart the cycle.

A vaginal ring must be used correctly to offer full benefits. That includes replacing it when needed and, in the case of an Annovera ring, taking it out and putting it back in on time. To stay on schedule, set reminders or alarms on your phone, or keep track on a calendar. You can also check out Planned Parenthood’s free birth control reminder app, Spot On.

The birth control ring is prescription-only. It does not offer protection against STIs.

The transdermal contraceptive patch releases estrogen and progestin through the skin and into your body to prevent pregnancy. There are two branded options available in the U.S.: Xulane® and Twirla®. Both patches may be worn on your belly, butt, or back. The Xulane patch can also be worn on your upper arm.

The birth control patch is worn for a total of 21 days. You will need to replace the patch during that time, wearing a new patch each week for three weeks. During the fourth week, you will not wear a patch so that menstrual bleeding may occur. The cycle then restarts.

A patch must be used correctly and on schedule to offer effective pregnancy prevention. Set reminders or alarms on your phone, keep track on a calendar, or use a birth control reminder app.

The birth control patch is prescription-only. It does not offer protection against STIs.

The birth control shot, also referred to as the depo shot or Depo-Provera®, is an injection administered about every three months. It contains progestin and works similarly as the above forms of hormonal birth control to prevent pregnancy.

Many individuals choose the shot for the convenience of the injection schedule and privacy. In order to experience the benefits of the birth control shot, you must stay on track and get a new shot every 12-13 weeks. In most cases, a doctor or nurse will give you the shot. In some cases, you may be able to get a supply of shots from a health center to self-administer.

Use a birth control reminder app or a calendar to stay on track with your injections.

Long-term use of the Depo-Provera shot may increase an individual’s risk for significant and potentially irreversible bone mineral loss. Additionally, it has been associated with an increased risk of breast cancer and is not recommended for those with a known or suspected breast malignancy.

There are two types of longer-term birth control: intrauterine devices (IUDs) and birth control implants. Both methods release hormones into your body to prevent pregnancy.

The implant (Nexplanon®) is a tiny, thin rod implanted into your arm that offers pregnancy prevention for up to five years. It must be implanted in a doctor’s office. If your family planning goals change, a doctor can easily remove the implant before it expires.

The IUD is a small device implanted into your uterus that prevents pregnancy. There are different types of IUDs that offer protection for varying amounts of time.

Hormonal IUDs release progestin to prevent pregnancy. There are four FDA-approved hormonal IUDs in the U.S.:

Paragard® is a copper IUD that does not contain hormones. It prevents pregnancy for up to 12 years.

An IUD must be implanted by a healthcare professional. It is reversible and can be easily removed.

There are many factors to consider when choosing a birth control method. While many individuals find these forms of longer-term birth control more convenient, they are typically more expensive than other forms of contraception.

Timing is essential with many forms of hormonal birth control. We make it easy to stick to the schedule, with free same-day delivery and medication management reminders in the app. In addition, our pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to answer any questions you may have.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Osteoporosis is a condition that weakens bones, increasing your risk for unexpected bone fractures, often of the hip, wrist, or spine. It affects an estimated 200 million people around the world, including 54 million individuals in the U.S. Though it isn’t curable, there are a variety of treatment options that can help protect and strengthen your bones. Read on to learn about the leading causes and treatment options of osteoporosis.

Osteoporosis, Explained | Alto Pharmacy

Your bones are constantly changing. When you’re young, new bone forms more quickly than old bone is lost, increasing your overall bone mass. This process starts to slow over time — typically beginning in your early 20s — and as you age, the reverse happens. Old bone disintegrates more quickly than new bone develops, decreasing your overall bone mass.

For those with osteoporosis, these changes are more pronounced, with lower than average bone mass and density. The inside of healthy bone resembles a honeycomb or a sponge, with many tiny holes. Osteoporosis, which means “porous bone,” gradually increases the size of these holes, lowering bone density and strength. As bones grow weak, brittle, and more porous, they become increasingly susceptible to fractures.

The condition is progressive. Without effective treatment, it may worsen, increasing your risk of a fracture. In cases of severe osteoporosis, even sneezing or minor bumps can fracture bone.

Osteoporosis is often preceded by a condition called osteopenia, which is characterized by less severe loss of bone density. Not all cases of osteopenia progress into osteoporosis, and simple lifestyle changes can help protect your bones and preserve bone mass. Regular bone density tests every two to three years are also an important component of osteoporosis prevention.

Sometimes referred to as a silent disease, osteoporosis often presents without noticeable symptoms. When symptoms do appear, they may include the following:

Posture changes such as stooping or bending forward

Since osteoporosis isn’t always accompanied by symptoms, it’s important to stay on track with bone density screenings as you age, especially if you are at increased risk for the condition. Many people first learn that they have osteoporosis after a fracture. If you have a family history of osteoporosis or a related health condition (see below), speak with a healthcare provider about your risk and recommended screenings.

Osteoporosis may be caused by a variety of factors, both preventable and non-preventable. Age and sex play the greatest role in the condition’s development. The condition affects women four times more often than men, and postmenopausal women have the highest risk of developing osteoporosis. This is due to how decreased estrogen levels after menopause alter the rhythm of bone remodeling, in addition to the overall aging-related loss of bone mass.

Though osteoporosis affects more women than men, everyone’s risk increases with age. Men over the age of 50 are significantly more susceptible to osteoporosis-induced bone breaks or fractures than those of a younger age.

The following factors may also contribute to the development of osteoporosis:

Bone structure and body weight — those with less body weight don’t have as much bone to lose and face a higher risk for osteoporosis.

Other health conditions including overactive thyroid, parathyroid, or adrenal glands; celiac disease; and inflammatory bowel disease

Previous hormone treatment, including for breast or prostate cancer or an irregular menstrual cycle

Previous bariatric surgery or organ transplant

Lifestyle factors including a history of smoking, alcohol use, a sedentary lifestyle, or calcium or vitamin D insufficiency

Bone mineral density (BMD) tests — also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans — are used to identify bone health issues in advance as well as to diagnose osteoporosis. 

A DEXA scan uses small amounts of radiation to assess the solidity of spine, hip, and wrist bones. Regular X-rays can only detect osteoporosis in more advanced stages.

This screening is recommended for all women over the age of 65 and all men over the age of 70, regardless of other risk factors. It may be recommended for postmenopausal women and men between 50-70 years old if other risk factors are present. Consult with your doctor about your preventative health needs and recommended screenings.

Treatment for osteoporosis varies by individual. Your doctor will make tailored recommendations about medications, diet, and exercise based on your needs. A treatment plan may include the following components.

Oral and injectable bisphosphonates, which prevent the loss of bone mass, are commonly prescribed for osteoporosis. Examples include:

Hormone therapy including estrogen and testosterone can also stop bone density loss. Estrogen has been associated with an increased risk for blood clots, certain cancers, and heart disease, and is typically reserved for younger women or women with menopause symptoms.

A medication called raloxifene (Evista®) offers similar benefits as estrogen therapy, but without many of the above risks. However, it is also associated with a higher risk of blood clots.

Three anabolic agents — romososumab-aqqg (Evenity®), teriparatide (Forteo®), and abaloparatide (Tymlos®) — are FDA-approved to treat osteoporosis. These medications support new bone formation and are administered as injections.

A biologic called denosumab (Prolia®) may be prescribed if other treatments aren’t effective. It is administered as an injection every six months.

There’s anecdotal evidence that some supplements can support bone health, however, research is still evolving, and few studies formally support the effectiveness of supplements. Speak with your doctor before taking supplements, as they may cause side effects or interact with other medications.

Nutrition significantly affects bone strength and health. Calcium and vitamin D are the two most important nutrients for managing osteoporosis. Calcium helps maintain strong bones and vitamin D allows your body to absorb calcium.

Nutritious sources of calcium include low-fat dairy products and dark green leafy vegetables. Vitamin D can be found in trout, salmon, and vitamin D-fortified milk and cereal. Some individuals get some of their vitamin D from sunlight, though this depends on your location and exposure to sunlight.

The recommended daily intakes for calcium and vitamin D vary by individual. General guidelines are below, but always check with your provider about your recommended intake.

Women with postmenopausal osteoporosis: 1200 mg of calcium and 800 international units of vitamin D

Women with premenopausal osteoporosis or men with osteoporosis: 1000 mg of calcium and 600 international units of vitamin D

Some evidence suggests that excess calcium consumption may cause kidney stones, calcium accumulation in blood vessels, and constipation. Always consult with your healthcare provider before taking supplements.

Other nutrients that promote bone health include:

Magnesium - found in whole grains and dark green leafy vegetables

Vitamin K - found in dark green leafy vegetables and canola oil

Zinc - found in whole grains, poultry, and nuts

Exercise is also part of living with osteoporosis. While certain types of exercise should be avoided given the risk for injuries, others offer many benefits for those with the condition.

Weight-bearing aerobic activities — performed on your feet — strengthen bones in your legs, hips, and lower spine. This includes walking, dancing, and low-impact aerobics.

It’s important to maintain good stability and balance. Try simple balancing exercises like standing on one leg or movement-based stability exercises, such as tai chi.

Unless otherwise informed by your doctor, avoid high-impact exercises and activities that involve frequent bending or twisting, as they may increase your risk of fractures. Always check with your doctor about which exercises are appropriate for you.

Take precautions to prevent falls both inside and outside of your home. You may wish to consult with your provider about whether or not they recommend an assistive device to improve balance and increase mobility.

Use the tips below as a starting point to prevent indoor and outdoor falls.

Avoid cleaning products that leave the floor slippery

Keep the area surrounding your house or apartment in good condition and free of clutter

The Bone Health & Osteoporosis Foundation (BHOF) and American Bone Health offer support and community for individuals living with osteoporosis.

Life with osteoporosis is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have, from medication side effects to navigating lifestyle changes. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with your treatment.

Alto’s board of advisors was formed in 2020 to deliver strategic guidance as we work toward a better healthcare system for all. With diverse leadership experience in the industry, our board of advisor members ensure that our efforts are both impactful and efficient, with services grounded in the highest standards of operational excellence.

Meet the Newest Members of our Advisory Board | Alto Pharmacy

Today we’re thrilled to welcome three new members to the board of advisors: Adam J. Fein, Harry Leider, and Brad Fluegel. Their passion and expertise will no doubt be an asset as we focus on reaching even more patients — and delivering even more comprehensive care — in service of our mission.

Read on to learn more about their backgrounds in the industry and join us in giving them a warm welcome!

Adam J. Fein, PhD, is the CEO of Drug Channels Institute, a leading source of industry research about pharmaceutical economics and the drug distribution system. Widely published in academic and industry publications, he also heads the Drug Channels website, praised by readers for its comprehensive and witty coverage of pharmacy benefit managers (PBMs), medication pricing, and other industry topics.

Delivering medications to our patients at the lowest price possible is central to our mission. Dr. Fein’s deep expertise in pharmacy economics supports our ongoing commitment to improve adherence rates by way of more affordable medication options and total price transparency.

“The pharmacy industry has entered a period of structural change. There’s a tremendous need for the cost transparency, efficiency, and commitment to patient well-being that Alto delivers. I’m thrilled to support Alto in building innovative solutions to foundational issues within the industry,” Dr. Fein said.

Dr. Fein holds a doctoral degree in managerial science and applied economics from the University of Pennsylvania’s Wharton School of Business.

Harry L. Leider, MD, MBA brings more than 25 years of experience as a senior healthcare executive to our board of advisors. Since 2018, he’s served as Chief Medical Officer and Executive Vice President of Gelesis, an innovative biopharmaceutical company.

In addition to his current leadership in the biotherapeutic space, Dr. Leider has broad experience in telemedicine, retail healthcare, laboratory medicine, and payor strategies, as former Chief Medical Officer of Walgreens Boots Alliance, Ameritox, and Care Improvement Plus.

Dr. Leider shares Alto’s commitment to driving lasting change within the healthcare system for better patient health. With both clinical expertise and executive experience, he’s spent his career designing programs, services, and intellectual property that improve health outcomes.

“Alto’s pharmacy model brings us closer to a future where everyone can receive the highest standard of care and is equipped to manage their health. I’m personally inspired by Alto’s bold vision for healthcare and look forward to what we can accomplish together,” Dr. Leider said.

Dr. Leider has served on the faculty of Harvard Medical School and the Johns Hopkins Carey School of Business and holds five patents in laboratory medicine.

Drawing on more than three decades of healthcare experience, Brad Fluegel is a strategic advisor to organizations, entrepreneurs, and other industry participants. Most recently he served as Senior Vice President and Chief Healthcare Commercial Market Development Officer for Walgreen Co, where he managed all commercial healthcare activities, from sales and contracting to biopharma relationships and market planning.

Previously, Brad oversaw Walgreens’ corporate strategy and business development as Chief Strategy and Business Development Officer. He also led Elevance (then Wellpoint)’s strategic planning and corporate communications as Executive Vice President and Chief Strategy and External Affairs Officer.

His expertise in strategic planning and operations will allow us to deliver an exceptional patient experience as we continue to grow.

“Since 2015, Alto has proven itself to be a leader in the rapidly evolving digital pharmacy space. It’s a privilege to support their efforts to redefine what’s possible in healthcare, and together we can deliver industry-leading care to more patients,” he said.

Brad earned a master’s degree in public policy from Harvard University’s Kennedy School of Government and a bachelor of arts in business administration from the University of Washington. He also serves as a lecturer at the Wharton School of Business.

Dr. Fein, Dr. Leider, and Brad join three other advisory board members: Dr. James Hildreth, the President and Chief Executive Officer of Meharry Medical College; Jennifer Kent, previously the Director for the California Department of Health Care Services; and Ajay Khatri, previously Alto’s Chief Strategy Officer. 

Dr. Hildreth, Jennifer, and Ajay have offered invaluable guidance as we’ve grown throughout the past two years, and we couldn’t be more grateful for their partnership and support.

Learn more about Dr. Hildreth and Jennifer’s healthcare experience.

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

Meet the Newest Members of Our Advisory Board

We’re excited to share that Alicia Boler Davis will be Alto’s next CEO. She will start on September 1, 2022. This is a big moment for Alto, so we wanted to share how we got here.

Introducing Alto’s New CEO - Alicia Boler Davis

We’re excited to share that Alicia Boler Davis will be Alto’s next CEO. She will start on September 1, 2022.

This is a big moment for Alto, so we wanted to share how we got here.

Alto has come a long way since we started out in 2015 by acquiring AG Pharmacy in San Francisco. Those first few months revealed just how much opportunity there was to build a better pharmacy experience for patients by rebuilding the entire end-to-end technology stack, combining it with a more efficient operational process, and backing it all with a talented and caring team. And with that insight we started forging ahead with bright eyes and relentless optimism toward our ultimate mission: fulfill medicine’s true purpose - to improve quality of life - for everyone who needs it.

Like any transformational startup, the journey has not been without its challenges. We’ve been consistently humbled by the complexity of the pharmacy industry and the challenges inherent in transforming how it works. Yet we’ve also been consistently amazed by how much opportunity there really is to make a meaningful difference in the lives of patients, and how receptive people are to a better solution. And through persistence and grit, combined with an increasingly talented and diverse team, we have overcome all the challenges that we have faced so far. We have served over 300,000 patients, with a 90 Net Promoter Score, are unit profitable, and are expected to pass $1 billion in annualized revenue in the next few months. We’re making faster progress than at any point in the company’s history. 

So if things are going so well, why are we hiring a new CEO? The opportunity ahead of us is huge, and along with that the challenges are getting more complex. Despite how far we’ve come, we are still only 0.2% of the total pharmacy industry market share. Capturing this massive opportunity will require leveling up our already world-class team with an even greater level of bold, rigorous, caring, experienced leadership.

As we got to know Alicia over the past few months, we realized that we had found the perfect partner to lead us through the next phase of Alto’s growth. Alicia was most recently the SVP of Global Customer Fulfillment at Amazon, and before that the EVP of Global Manufacturing at General Motors. Alicia grew up in Detroit, and got her first job as an engineering intern at GM. Over the next 25 years she worked her way up to running a plant, then running multiple plants, then running all of quality and customer experience, and finally running all of global manufacturing. She was the first Black woman to accomplish each of these things at GM. In 2019 she joined Amazon, and was quickly promoted to the prestigious S-team, which is the exclusive inner circle of the most senior leaders at Amazon. When she was barely a year into the job, the Covid-19 pandemic hit, and over the next two years she oversaw Amazon nearly doubling its fulfillment network capacity to keep up with surging demand, while managing a team of over 800,000 people. Alicia built a reputation for successfully navigating the toughest challenges while driving unparalleled growth by bringing out the best in her teams.

From the day we started, we have always tried to build a team that is balanced between the rigor and operational excellence needed to execute in this complex industry, along with the heart and care that we saw was missing from the industry. These are not mutually exclusive attributes, but they are extremely rare to find in the same person. In Alicia, more than any other leader we’ve ever met at her level, we’ve found someone who can bring that balance that we seek. She is one of the world’s top executives in operations, and is a rigorous, disciplined operator. And at the same time, she leads with real heart and care for the people that she serves and that she works with.

With Alicia coming on board as CEO, Matt and I will continue to be involved full-time, both in supporting Alicia and with our own portfolios of projects to lead. We’re more committed than ever to Alto, and more excited than ever about the real opportunity we have in front of us. And we are so early in this journey that it is clear there is no shortage of work to do and problems to solve. Matt and I have never been attached to any particular role or title, and have each worn many different hats over the years. We are humble about what we are good at and what we are not, and just want to do what is best for our team in order to achieve our mission. In the short term we will focus on ramping Alicia up, and after that we will work more on what we do best: building our long term strategy, leveraging our entrepreneurial spirit to spin up new business lines, defining and evolving our culture, and sharing the Alto vision.

We are just getting started, and there is still so much opportunity to fix this broken industry, and truly help people live happier and healthier lives. We can’t wait to see what we will do together in this next phase of the Alto journey.

With many variables involved in an individual’s fertility, learning more about your reproductive health can help you manage expectations about your body’s response to fertility treatment. The anti-mullerian hormone (AMH) test, which measures your body’s levels of a hormone associated with ovarian reserve, is one potential source of information for those experiencing infertility.

AMH Testing in Fertility Treatment

While the AMH test can reveal certain factors related to your reproductive health, it is not relevant to all aspects of fertility, or all types of fertility issues. Here’s more about the AMH test, including what it can and can’t tell you.

Anti-mullerian hormone is a hormone that affects how a baby’s reproductive organs develop while in the womb. Male babies have higher levels of AMH than female babies.

AMH is also related to a woman’s ovarian reserve. Cells inside the ovarian follicles — fluid-filled sacs that release an egg during ovulation — produce AMH. An individual's levels of AMH correspond to their egg count, with higher levels of the hormone typically indicating a higher ovarian reserve.

Unlike many other hormones related to reproductive health, AMH levels remain steady throughout an individual’s menstrual cycle. This means that you can have your AMH levels measured at any time, unlike some other fertility-related blood tests.

An AMH test is a blood test that measures your levels of AMH, revealing the approximate number of eggs in your ovarian reserve that may be used for ovulation. It provides a snapshot into one aspect of your fertility, rather than a precise look at the whole picture.

The AMH test consists of a simple blood draw. It typically takes about a week for test results to arrive. There are at-home AMH tests available, however, it is important to discuss the results with a healthcare provider.

Below are general ranges of AMH levels, measured in nanograms per milliliter. Your provider can give you a clearer sense of what your AMH levels indicate.

An AMH test is an indication of the number of eggs remaining in your ovarian reserve. This is particularly relevant to in vitro fertilization (IVF), since one goal of IVF is to retrieve as many mature eggs for fertilization as possible. Your AMH test results may also inform your individual medication protocol for IVF, as they can help your provider anticipate your body’s response to ovarian stimulation medication.

The AMH test can also indicate the pace at which your ovaries are aging.

While AMH levels are helpful for determining egg quantity, they do not reveal anything about the quality of your eggs. Egg quantity factors into IVF success rates — the more eggs retrieved, the higher your chances are of producing multiple healthy embryos that may be placed into the uterus — but quality is also extremely important. It is possible to have a low ovarian reserve but a high percentage of viable eggs, in which case a successful IVF cycle would be more likely.

It is also possible to experience infertility despite having normal AMH levels. Other factors that may affect your ability to conceive include your age, lifestyle habits, ovulation disorders, uterine abnormalities, and endometriosis, among others. Sperm count and mobility also factor into a couple’s fertility. There are many diagnostic tests a reproductive specialist may use to evaluate your remaining egg supply and recommend the best treatment plan.

Read Infertility, Explained for a more comprehensive overview of common fertility issues.

A fertility pharmacy partner you can rely on

At Alto, we’re here for you at every step of your fertility journey. We offer free same-day delivery of your medications, with discreet packaging, fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists, and support with insurance and savings opportunities.

To learn more about how Alto can support your fertility treatment, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Receiving feedback from your manager or coworkers can be scary. Giving them feedback can be even scarier. It’s why many companies lack a culture of regular feedback and rely instead on a stress-inducing biannual performance review cycle.

How We’re Making It Easier (and More Fun!) to Give Teammates Feedback

One of Alto’s company values is “communicate with candor.” To make sure we live by this value, we recently set out to make peer feedback more frequent, honest, and fun. Here’s how it went.

Earlier this year, Alto’s patient care team hosted its first Speedback session, inspired by a Thoughtworks idea of the same name.

Set aside a dedicated hour for team members to give feedback to one another.

Group participants into pairs and have multiple rounds. Each round lasts four minutes, giving both participants two minutes to speak.

Change pairs after each round, ensuring that each participant meets once with every other. 

Each round begins with highlighting what the feedback recipient is excelling at, then noting opportunities for improvement.

By creating a fun format for discussions and encouraging constructive criticism, we hoped to take the fear out of feedback and give every participant valuable and actionable insights.

Because Speedback rounds are, well, speedy, it was important that the team came prepared.

A week before the session, every team member identified specific areas they wanted to improve in, from communicating more effectively to keeping coworkers motivated. These were then posted in Lattice, an HR tool we use at Alto, for everyone else to see.

Over the next week, team members reviewed one another’s feedback requests and brainstormed suggestions to share on Speedback day. If a team member wanted tips for writing cleaner code, other Speedback participants could look through past code review sessions for examples.

Since Alto is a remote-first company, the team also had to plan for a virtual Speedback session. We used Zoom breakout rooms, which include helpful features such as countdown timers for the rounds.

After some initial finicking with Zoom, the team quickly got into a groove. Each participant received valuable feedback from every other, which they used to grow over the next few months.

Feedback was also cross-functional. Engineers received feedback from product managers, and product managers received feedback from engineers. Managers received feedback from their reports and vice versa.

“With the feedback I received, I realized that each person responds best to slightly different communication styles,” says Patient Care Engineering Manager Nick Helvig. “It’s helped me better understand and collaborate with the entire team.”

The team’s first Speedback session occurred two months before Alto’s annual performance review cycle. This gave participants valuable information to use for improvement, as well as documentation of their strengths, weaknesses, and growth.

As one team member put it, “What I appreciate most about Speedback is the opportunity to get super clear on where both you and your teammates are looking to improve. It’s also a great way to track your progress and see how far you’ve come in the past two months, the past year.”

Patient Care has since made Speedback a ritual every two months.

To make sure there is useful follow-up to prior feedback, the team has adjusted the timing of rounds from four minutes to six. The first two minutes are now dedicated to revisiting items from the last session, allowing participants to reflect on their progress as well as remaining opportunities for improvement.

Curious to give Speedback a try? Start by putting three blocks of time on your team’s calendar: the Speedback session, a reminder to request feedback for yourself, and a reminder to prepare feedback for others.

Ultimately, Speedback does a lot more than make feedback less scary — it integrates regular, honest discussions into a company’s culture. We hope you’ll find it as helpful as we have!

Many oral medications are available in several formulations that affect how the medication is released into your bloodstream. If your medication is followed by letters such as ER, XR, SR, CR, or DR, it means you’re taking a modified-release formulation. With these formulations, a medication’s effects are either extended over a longer period of time or delayed. They are often prescribed to decrease side effects or reduce the number of pills you have to take.

The Difference Between Extended- and Immediate-Release Medications

It’s important to understand how your body absorbs a medication. Read on to learn the key differences between the available medication formulations.

The standard dosage form of most oral medications is immediate-release. If your medication is not followed by one of the letter combinations above, it typically means that you’re taking an immediate-release formulation.

These medications are both fast-acting and short-lasting. Your body absorbs an immediate-release medication quickly after it enters your bloodstream, with the medication effects peaking within a small window of time. This can lead to greater side effects in some cases.

Your body’s levels of an immediate-release medication decline as it leaves your bloodstream. As a result, many immediate-release medications require you to take multiple doses each day so that you maintain a consistent amount of it.

An extended-release medication — typically indicated on the prescription label with an “ER” or “XR” after the medication’s name — prolongs a medication’s effects and its levels in your body. With many medications, this reduces the number of daily doses.

Examples of extended-release medications include:

Estradiol ER transdermal patch (Alora®, Climara®, Dotti®, Lyllana®, Menostar®, Minivelle®, Vivelle-Dot®)

Metformin ER (Fortamet ER® , Glucophage XR®, Glumetza®)

There are two subtypes of extended-release medications: sustained-release and controlled-release. Since SR and CR formulations fall under the category of extended-release medications, they may be designated by an “ER” or “XR” after their name.

A sustained-release formulation extends a medication’s release into your body, prolonging its effects over a longer period of time. They are typically prescribed to decrease the doses required on any given day.

While an SR medication’s release is gradual, it does not mean there will be a consistent amount of the medication in your body over time.

A controlled-release medication is designed to keep a consistent amount of a medication in your body over a specific window of time. These medications differ from SR medications in that they precisely control medication levels in addition to decreasing daily doses.

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How We’re Making It Easier (and More Fun!) to Give Teammates Feedback

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