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It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

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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.

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies.

Alto Pharmacy Named Great Place to Work®

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits. This important recognition is a testament to the dedication of the entire Alto team and the vision of our founders to create a healthcare company truly anchored on the needs and experiences of the customer.

80% of our team says that Alto is a great place of work, compared to just 59% of employees at  other companies that participated in this year’s assessment. Here are other key takeaways from our team’s’ responses:

93% of our team members say that you are made to feel welcome when you join Alto.

88% say that people care about each other here.

86% say that they are able to take time off from work when needed.

Every company has its own unique culture, but there are two things that all great workplaces share: trust in company leadership and a strong sense of pride in the work. For many Alto team members, being part of a mission-driven company is one of the best parts of working here. 

Our mission — to improve the quality of life for everyone who needs medicine — guides us in every business decision, every day. From fostering an inclusive culture that invests in talent from the same communities as our patients, to building a pharmacy model that meets individuals where they are in their health journey, everything we do at Alto is anchored on delivering meaningful change. 

When asked what makes Alto a great place to work, our team members emphasized our guiding company values — including our commitment to putting patients first and leading with empathy — and getting to spend each workday with colleagues who are also inspired and motivated by those values.

“Our bold, patient-centered mission creates a powerful level of empathy across the entire team,” shared Rob Anderson, Alto’s Head of Talent . “The people who work here are one of the best parts of coming into work, and one of the top reasons our workplace is so rewarding.”

And taking care of our team members is just as important as ensuring we leave no patient behind. In response to the past year’s unprecedented challenges, we introduced Alto Recharge Week, which includes expanded time off for all team members. This reset period allows team members to unplug and recharge, and it’s also a small show of  appreciation for how they supported our patients and healthcare providers throughout these challenging times.  

It’s an exciting moment to be part of Alto’s mission. Since our founding in 2015, we’ve been focused on delivering a totally new model of pharmacy care. Our community-based, courier-first pharmacy model simplifies the entire prescription process and is tailored to each patient’s unique needs, leading to better  outcomes, healthier lives, and happier customers. And with every year, Alto’s impact continues to grow:

More than 36 million individuals now live within Alto’s free same-day courier service zones. 

In the past twelve months, we opened new locations in New York City, Houston, Dallas, and San Jose and expanded our coverage areas in Seattle, Las Vegas, and Denver. 

We've expanded our specialized resources for patients living with diabetes and managing heart and lung conditions .

We’ve accomplished so much over the past six years, and we’re still just getting started.

“I don’t know a single person who hasn’t needed something from a pharmacy at some point, and there’s still so many people across the country who have yet to experience our unique community pharmacy experience,” Alto’s Recruiting Manager Lauren Binet said. “That potential for impact is incredibly motivating.”

As our geographic footprint has grown, so has our team. In the past two years alone, we’ve quadruped our team to more than 1,000 Altoids!

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy.

View open roles in design, engineering, IT, sales, patient care, and more.

About Great Place to Work Certification™

Great Place to Work® Certification™ is the most definitive “employer-of-choice” recognition that companies aspire to achieve. It is the only recognition based entirely on what employees report about their workplace experience – specifically, how consistently they experience a high-trust workplace. Great Place to Work Certification is recognized worldwide by employees and employers alike and is the global benchmark for identifying and recognizing outstanding employee experience. Every year, more than 10,000 companies across 60 countries apply to get Great Place to Work-Certified.

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.

In recognition of Women’s History Month, we highlight four women at Alto shaping the future of pharmacy. These leaders share their advice for women in the workplace, their unique super powers, and what they appreciate most about Alto's culture.

Celebrating Women at Alto Pharmacy

Liz Kelly, Sr. Director Sales, Fertility 

I'm responsible for hiring, coaching and supporting the needs of the national fertility sales team. I also work closely with fertility business and operations teams to deliver on our clinic and customer promises.

Before joining Alto, I was finishing up a sabbatical where I spent my time volunteering on the board of a non-profit called ServeHAITI. Prior to that, I was the West Coast Area Business Director at EMD Serono and worked with Matt and Jaime [Alto’s co-founders] to secure a contract to distribute fertility meds when they were still working out of AG Pharmacy!

What do you appreciate the most about Alto's culture? 

Hands down my favorite part of being on the Alto team is that the patient is truly at the center of every decision we make. I value that we make business decisions with our mission in mind.

What do you like doing outside of work?  

Of late, my favorite pastime is heading to the dog beach with my rescue, Bodhi, who has been the best medicine to ease some of the COVID-19 isolation I experienced over the past year. Before the pandemic, I made sure to travel to at least one new international spot a year. I love the experience of getting exposed to all things about another culture: cuisine, culture, belief systems, language.

I like to think that my super power is seeing the greatness in others, sometimes before they see it in themselves.

I aspire to live by the motto "be the change you wish to see in the world." I encourage women to speak up for what they believe is right, even if nobody else agrees. That includes planning for your own career path and making it a priority to develop your skill sets so that you are prepared to climb the ladder that serves your own greatness.

I graduated from pharmacy school in May of 1979 and started working at AG Pharmacy after passing my boards later that year. I bought AG in 1998 when the previous owner wanted to retire - he had been with AG since it first opened in the early 60's.

My family moved to San Francisco from Hong Kong when I was five years old. Our story is one similar to those of many immigrant families who came to America looking for a better life in search of the American dream: own a home, have a car, raise children safely and give them the opportunity of a good education and a chance to have a better life. My parents raised their children here, emphasizing family, hard work and education. They lived their American dream, and I have them to thank for all that I am today.

What’s your favorite thing to do outside of work? 

I love to travel. There are so many unique places to visit in this world. With the different cultures, the food, and the amazing sceneries/landscapes, there are endless things to see and experience! 

The thing I appreciate most about Alto's culture is that everyone works so hard together to bring about the best pharmacy experience for all our customers. You can feel the energy and the motivation of all the Altoids. I cannot emphasize how amazing it is to be a part of this team and to watch Alto grow and evolve into the pharmacy of the future and the pharmacy of our dreams!

What’s your favorite memory thus far at Alto? 

In the very early days, when Alto was still Scriptdash Pharmacy, a customer needed to get her trigger shot [as part of a fertility protocol] within the next few hours. It was close to rush hour, and we had no couriers available to deliver to the South Bay. Our CEO Matt came to the rescue on his motorcycle, and off he went to make the delivery. It was such a wonderful and warm feeling to watch and cheer him on together. That is truly what Alto love is all about!

I manage our amazing IT Support team, helping all Altoids get the technology support they need, when they need it. 

For the better part of the last decade I have been managing IT Support teams. From Facebook and Twitter to Lyft and Uber, I’ve seen it all (or at least most of it!).

Our incredible dedication to our mission. In my short time here, I truly see us putting patients first, and it’s moving to see. 

What do you like doing outside of work? 

I’m a big traveler, but since COVID-19 has put a damper on that, I enjoy flying around Colorado with my partner in our vintage Beechcraft Bonanza. I also love hopping on my motorcycle and just exploring! 

I’m in love with Central and Eastern Europe. Some of my favorite places are Prague, Vienna and Budapest. 

I’m originally from Iran but moved a lot growing up, including Oklahoma, Australia, Qatar, Kuwait, and Chicago. I have been in San Francisco for the last six years. I stumbled across software engineering in college and found a passion for building products and teams. I joined Alto as the third engineer and this is now the largest company I’ve ever worked at. 

I lead a group of 20 engineers across three teams. Two teams are focused on getting prescriptions ready to schedule quickly and accurately, and one is focused on enabling faster, higher quality, and more enjoyable product development across the broader product and technology organization. My work involves a lot of collaboration, creativity, transparency, and flexibility. 

I was an early software engineer at a small startup; before that I was a hybrid software engineer and product manager at a design and development studio. 

I like how passionate everyone is about what they do. 

I’m at my best managing a crisis or finding a path through conflicting strong opinions. 

I want to start with some advice for our allies: get more curious about the experience of the women you work with and learn about ways you can support and amplify the work of the women around you. Diversity, equality and inclusion is a team sport and, even if we win a game or two, it’s about the continuous pursuit of excellence. 

For my fellow women at Alto, I wish I knew earlier to focus more on improving my craft and impact so I can get a seat at the table, rather than trying to juggle advocacy and my own work. Once you’re at the table, you can really advocate for hiring, growing, and retaining women. 

To learn more about the work of our six employee resource groups (ERG’s) focused on building community - including Umoja (Black), Auténtico (LatinX/Hispanic), Women (WOAA), Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents - read our 2020 Diversity, Equality and Inclusion Report. 

Are you passionate about shaping the future of pharmacy? Join us as we deliver our industry-leading pharmacy care to millions of Americans. 

Mike McClay has spent the better part of two decades working in Silicon Valley. Here, he chats with software engineer Akash Gupta about the road from Software Engineer to VP, what it’s like to work in digital health, and his best advice to both independent contributors (ICs) and managers. 

Get to Know Alto’s VP of Engineering, Mike McClay

I'd love to first understand a bit about you personally. What do you like to do in your off time? What’s something most people don't know about you?

I grew up in Orange County, which is pretty suburban, so that afforded us a lot of time outdoors as a family. A life goal of mine is to do a solo hike of the John Muir Trail. The route starts in Yosemite Valley and heads south to Mt. Whitney. It’s about 225 miles and typically takes a few weeks to complete.

Currently though, I have a two-year-old and a four-year-old, and we have another baby on the way, so my outdoor activities tend to be much shorter and closer to home. I got into road biking about 10 years ago and transitioned to mountain biking a few years back when my family moved to Marin. Being able to get out onto the local trails a couple times per week is an amazing opportunity to get a great workout in, and unplugging does wonders.

Finally, a ton of family time with my partner and kids. A big reason I decided to join Alto is because it provides a great balance of simultaneously being a high growth startup but it’s also a company that has an eye on culture and achieving work-life balance. At Alto, we're playing to win, and we’ve got a lot of things to get done, but there's a lot of support and representation for people with families with kids. It's nice to be able to work hard towards an incredible mission but also not have to sacrifice too much on the family front; so outside of work, I’m mostly focused on spending quality time with my family getting outdoors, getting to the beach, and things like that.

That's very exciting, having another child on the way. How has COVID-19 impacted your responsibilities of being a VP Engineering and a father?

Life is a lot harder during COVID, though I say that with a fair amount of awareness of the privilege my family and I have. On the home front, we are constantly trying to find that balance of keeping the kids entertained and learning but also doing it in a safe way that protects everyone. My wife and I are pretty fastidious about keeping the house organized and clean but that’s relaxed quite a bit during this time; there’s a lot of resetting of expectations, and I try to do as much as I can to support my wife.

Professionally, probably about half of our engineering team has interviewed and onboarded since the shift to remote work in March, and I’d say we are still iterating and adapting each month to work better in a fully remote environment. It’s been incredible to see our teams adapt to this new style of work, and while it’s not quite the same as our in-person environment was, it’s been really cool to see the team grow and have our organization make a bigger and bigger impact for our patients each month.

I'd love to talk about some of your past experiences. You went to the University of California, Berkeley (Go Bears!), then Expedia, then Uber, and now you're at Alto. What prompted each of those transitions?

Yeah, I’m kind of an outlier in the tech world in that I’ve only worked at 3 companies since graduating undergrad in 2004. I think I’ve been fortunate to find myself at companies that have had no shortage of growth opportunities and that led me to stay for considerable amounts of time at both Expedia and Uber. 

Towards the tail end of my tenure at Expedia, I was managing the engineering team of a start-up that Expedia had acquired, and I knew in my heart that I wanted to move to a much smaller company. I spent a few months talking to a bunch of early stage start-ups but hadn’t found anything that felt right yet.

At the urging of my recruiter, I took a call with a company called Uber, which had seemed way too “big” for what I was looking for in that the engineering team was about forty people. Despite the role feeling different from what I was expecting, I was excited by the mission and the team, so I made the leap. Fast forward six years or so and it was an amazing ride, full of a lot of ups and definitely some learnings, but it was a truly formative experience for me.

Uber ultimately got to a point where I struggled a bit to pinpoint the impact I was making, and things overall at the company just felt slow. I wanted to work on something that was even more mission-driven, and one of my colleagues insisted that I chat with Alto. I was introduced to Jamie (Alto’s CTO). We talked over a number of months and found Alto’s needs and the challenges I was looking to solve aligned in a great way. So that's why I ended up joining.

Each of the companies that you’ve worked at have had large operational components. What are some of the key pieces to creating a strong partnership in a tech-enabled company?

What I would definitely say is that the tooling and the product that we built for ops at Uber was, at the time, world-class; it was just beautiful. Design was a first class citizen in our operational tooling because the workflow of our ops team was so critical to our company’s success. 

This is something that Jamie and I bonded over about Alto; our internal platform (called Wunderbar) powers the functionality that allows us to process our patient’s prescriptions in an efficient and effective way. Getting this right is critical for our patients, and the fact that we put so much time and energy into getting the technology platform right goes a long way to build a great working relationship with our operations team. 

Additionally, I’m passionate in general about operations since it’s often an area of the business that creates strategic advantages over competitors. And what I love about building software with operations is that it can’t be copied easily by competitors since there is no public surface area to observe. I view our task as an engineering team as getting to where we're crushing it as a business because we have nailed supporting operations with our product engineering work.

On that note, would you say Alto is an operations company, a pharmacy, or a tech company?

We aspire to a model of cross-functional leadership, whether it's between Engineering, Product, Ops, Growth, Marketing—whatever it is, the leads of areas and even the team members of each area need to be empowered to achieve the mission that they're setting out to do. If that's to enable, say, the flow of prescriptions coming through our system, maybe you could call that Ops-led, but at the end of the day, multiple functions have to come together to solve the problem. I almost want to call it vision-led.

There’s a time and a place where we need to be creating a faster horse, and there's a time and a place where we need to be thinking one to two years out about what the step up is from the faster horse: bringing the car into the situation, so to speak. Ultimately we need to be thinking on multiple time horizons at the company, and depending on the time and place and the strategy, you might see one function spiking up in terms of what we're rallying around versus another.

The engineering team at Alto has grown from eleven engineers and four managers when you started a year ago to more than fifty-five engineers with nine managers, directors, senior managers, and managers. What would you say has enabled that dramatic growth, and how do you plan on ensuring that that growth is well-managed?

For engineers, there are a lot of choices out there, and a big part of our hiring process is spent not only assessing technical skills, but also looking for signals that candidates align well with our patient-focused mission. From the beginning, we created an interview process that is fair and equitable, and that resonates strongly with our candidates. From there, we set out some really big goals that energized the team to push to make it happen.

I'm really proud that we've grown while maintaining a solid level-mix in terms of junior, mid-level, and senior engineers. Our engineering team is ~25% female, and while we only have single digit percentage points of representation of other underrepresented groups, representation is improving every quarter. Our goal over the next several years is for the team to achieve 50% gender representation and 30% from other underrepresented groups, so that our engineering team is representative of those we ultimately serve: our patients.

In order to make sure this growth is well managed, my philosophy is to hire or grow Engineering Managers well in advance of the acute need. On the manager side—and this was a big learning for everyone at Uber—we’d grow a team of fifteen to twenty engineers under a manager and not really have a great plan in place for how to bring in additional leadership and get the teams down to a right size of ten. When we approached that number, we'd battlefield promote someone and everything just felt strained. So I'm really proud of the fact that even at nearly seventy people now, we have a management team of nine that could actually support one hundred people pretty well. As the team continues to grow we’ll be making sure to stay ahead of the growth on the management side.

On that note, Uber has been reported to have an unhealthy culture. What have you learned from it to engender a more positive, inclusive culture at Alto?

Yeah, I’ve had a lot of reflection on this and a lot of learnings from my time at Uber. First, it’s that as a leadership team, we need to be vigilant about creating a team environment where team members feel they can do their best work. We need to always have great managers leading teams that are right-sized, and we need to have people-focused cultural values that help guide our behaviors and how we interact with one another. 

At Alto, half of our cultural values are focused on skills that foster an environment where folks can do their best work. Yes, we're thinking constantly about impact, but we make sure to hold ourselves to a high interpersonal bar. This type of behavior has also been institutionalized at Alto in our engineering career ladder. Culture amplification is one of the five skills engineers are evaluated against, and I think it’s a very strong signal into what we hold dear and how we want to roll here.

Finally, I’ve put a strong emphasis on making sure that interviews at Alto assess behavioral skills in addition to technical ones. We didn’t do this well at Uber for too many years, and I believe it led to some of the cultural negatives that you’ve likely read about in the news. To me, it’s critical that we hire really talented folks who can work seamlessly with one another. Getting signal on this during our interview process is a big part of growing a healthy engineering organization.

You've gone from being a Software Engineer to Tech Lead, Engineering Manager, Director, and now, VP. What advice would you give someone at each of those stages? What advice do you wish you had back then?

The main piece of advice I’d relay is to make sure that you spend enough time in each role to get solid proficiency. I’ve come across a number of folks in my career who look to move through roles as quickly as possible, and I think that doesn't allow for solid bases of knowledge to be built up. The foundation I built up in my experience as an engineer I believe resonates with engineers; I’m not just a people manager that helps coordinate minutiae. Additionally, a lot of the skill-building in these roles happens as you encounter various real life situations; the only way to accumulate experience is over time. So my advice is to be patient.

I would definitely encourage everyone to work at a company where there are clear career paths for both ICs and managers. You should never feel like you need to move into management to “grow in your career.” One of the first things we put in place after I joined Alto was a career ladder so that folks could reason about how they wanted to grow over time and come up with a growth plan with their managers.

Finally, don’t go too long in a role or at a company where you don’t feel challenged and don’t feel like you are growing. To me, growth and challenge are proxies for job satisfaction. I would say I've achieved it about 80 to 90% of the time in my career. If you're not in a place where you're feeling like you're growing, you should go somewhere else.

What would you say to someone considering working in digital health? What are some challenges and benefits in this space?

It's not so fraught with red tape that you can’t get anything done. There is a process to work through with HIPAA (Health Insurance Portability and Accountability Act) to ensure patient privacy; there is a massive set of opportunities that support all of the activity in the space; and there are seams where startups can begin disrupting entrenched players.

There’s also a massive opportunity to solve hard technical problems while achieving these amazing, mission-driven ends. I think sometimes it seems that those can be separated to where it’s almost mutually exclusive. While we don't yet have the volume nor traffic that you might receive at companies like Uber or Google, there are still meaty technical challenges that haven’t been solved before.

What disruption is good in healthcare and what may not be?

The good disruption comes in places where companies can plug into an existing experience that patients go through to solve a problem and figure out new ways to address that problem. In the pharmacy space, we are disrupting the brick and mortar pharmacy experience that is effectively in the business of selling you Coca-Cola while you wait for your medication. 

Bad disruption would be anything that goes against protecting a patient or their privacy. At Alto the engineering and security teams are tightly coupled so that we can best solve for the needs and privacy of our patients.

You mentioned technical challenges. What would engineers and other technical people get excited about in this space?

We don't yet have our architecture mapped out for scaling 100x on our business over the next couple of years, and it’s been really exciting to start to discuss our technical plans to enable that. At Uber, we went from a monolith to a full micro SOA (Service-Oriented Architecture)—both extremes that had quite a few problems as implemented. At Alto, we aim to find a better middle ground. 

Additionally, we need to think about what the pharmacy experience will look like five to ten years from now and start building some of the pieces that will work us toward that future. Safety and accuracy are incredibly important to us now, but at one hundred times our scale, we’ll need to be constantly innovating our technology so that we can minimize / eliminate errors in our operational process. 

We’re also bringing data silos together that have never been joined before. For example, as many as 50% of prescriptions are not picked up for retail pharmacies. Doctors have no idea which of their patients pick up medications or not. Insurers don't know what happens to patients after they take their medication. We are the interconnect between all of these customers.

As we grow, that data is going to grow inside of our systems. The information and the insights that we can derive from it is going to be incredibly powerful. But we're going to need a ton of awesome data analysis, products that allow us to collect the data while respecting patient privacy, etc. I'm really excited about that.

What are you most proud of from your time at Alto so far, and what are you most excited about in the next year?

What I'm most proud of is the team that's been hired. They are just amazing. Last year, we had a team of eleven engineers with such a large surface area: fulfillment, operations, customer app, customer website, our provider portal, etc. With so much to do across a team of that size, we were constantly making really hard prioritization decisions and were not able to tap into what we saw as our full potential.

Fast forward to today, we're now in a world where we have dedicated teams for surface areas, and we’re solidly parallelizing efforts. Seeing the bandwidth, the throughput that's going to be rolling out each quarter, is really cool. We're going to have orders of magnitude more output each quarter than we did a year ago. That's what I'm most proud of now.

What am I most excited about? There's the business aspect, expansion. We've really only covered six markets and are now looking at covering many, many more lives. The next couple of years are going to be a lot of fun.

Last question. Someone's considering working at Alto: Why should or shouldn't they join?

Alto’s at a stage where things are changing constantly. Folks who like dynamic environments will thrive here, as the work is challenging, and we are trying to solve problems that have not been solved before. Given that Alto operates within a multi-sided network, we have a lot of opportunity to create value, but it also means there are multiple players to think about when building a product. There's a richness to our patient, provider, and insurer base that makes it both challenging and exciting to make sure that we're finding the opportunities that deliver value to broad strokes of folks without leaving others behind.

Finally, engineers should join if they want to be part of a mission-driven company, enjoy working in an inclusive environment and diverse team, and like to be at the intersection of technology and the physical world, whether that's operations, delivery of things to humans, etc. If we succeed,  the way society thinks about health, prescriptions, etc, ten to twenty years from now will look very different because of the work we’re doing here. If that's inspiring to you, and you want to be part of that, you should join.

Interested in joining the team? Reach out to us on LinkedIn.

When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

What’s the Difference between Type 1 and Type 2 Diabetes?

Put very simply, diabetes is a health issue that affects how the body converts food into energy. This simple understanding is complicated, however, by the fact that it’s actually a term for several conditions. When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

Your cells use a simple sugar called glucose for energy. Your body obtains it by breaking down the carbohydrates that you eat. Once the glucose enters your bloodstream, your pancreas releases insulin in response, which promptly helps move the sugar out of your blood and into your cells. In a person with diabetes, however, one of the following things happens: 

The pancreas does not produce any insulin at all

The body doesn’t respond to insulin in the right way, which is known as “insulin resistance.”

Without treatment, a person with diabetes will develop a condition called high blood sugar, which is just as it sounds—too much glucose in the blood. This can lead to serious and even life-threatening complications such as heart disease, vision loss, kidney disease, or nerve damage. There is currently no cure for diabetes, but it can be managed through lifestyle interventions and, depending on the type, oral medication and/or insulin injections. 

According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans, or about 1 in 11, have diabetes. In addition, it’s estimated that 1 in 3 adults are currently at serious risk of developing type 2 diabetes, meaning more than 40% of American adults are in some way affected by this disease. In case you glossed over that last statistic, we’ll let it sink in again. Experts believe that nearly half of all American adults have either diabetes or prediabetes. 

To understand this disease’s startling prevalence, let’s take a look at how and why each type occurs. 

Type 1 diabetes: The immune system on the attack

Type 1 diabetes is an autoimmune condition that occurs when the body mistakenly attacks the pancreas with antibodies. This destroys the pancreas’s insulin-producing cells, meaning people with type 1 diabetes don't produce any insulin at all and must rely on insulin injections to control their blood sugar. 

Because type 1 diabetes commonly begins in childhood, it used to be known as juvenile-onset diabetes. However, it can happen at any age to people of all races and body sizes. The CDC estimates that it affects nearly 1.6 million Americans, making it much rarer than type 2 diabetes.

Symptoms of type 1 diabetes usually come on very quickly and can include excessive thirst or hunger, frequent urination, sweating, nausea or vomiting, and weight loss. The cause is unknown, but genetics plays a role and those with a family history of type 1 diabetes are at increased risk. If you experience these symptoms, it’s important to contact your doctor right away.

Type 2 diabetes: A silently growing epidemic

In the case of type 2 diabetes, the pancreas is usually able to produce some insulin. The problem is either that it’s not enough insulin or the body isn’t able to use it properly. This means glucose doesn’t easily reach the body’s cells to provide essential fuel. 

Type 2 accounts for over 90% of all people with diabetes. It develops over the course of many years due to a mix of genetic, lifestyle, and environmental factors. Unlike in the case of type 1 diabetes, those at risk for type 2 can often prevent its onset through lifestyle interventions such as losing weight, eating healthy, and staying active. 

This high-risk phase is known as prediabetes, and occurs when a person’s blood sugar levels are significantly elevated, but not high enough for a type 2 diagnosis. It’s estimated that more than 88 million adults have prediabetes and 85% of them have no idea. 

So how do you determine if you’re within this group? Well, you could be at higher risk of prediabetes if you are:

Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander (The reasons are not yet understood, but researchers have found varying rates of diabetes among different racial and ethnic groups)

High blood pressure or take medication for it

Low HDL cholesterol and/or high triglycerides

Been diagnosed with Polycystic Ovary Syndrome (PCOS)

Falling into just one of these categories puts you at higher risk, however they do not mean that a diagnosis is in your future. Staying active and eating well is the best way to lower your risk.

Indicators of type 2 diabetes include tingling in the hands and feet, excessive hunger or thirst, fatigue, frequent urination, slow-healing cuts and bruises, and blurry vision. Quite often, however, there are no symptoms at all or they develop very gradually. If you’re feeling uncertain, talk to your doctor. They may recommend an A1C blood test to check your average blood sugar levels over the past few months. The American Diabetes Association offers a free one-minute test that can help you or a loved one learn more about your risk. They also provide a variety of tools focused on preventing or managing a diagnosis, from recipes to fitness plans.

Since a type 1 diabetes diagnosis means you cannot produce your own insulin, you will require regular insulin injections and frequent testing of your blood sugar levels. Even with an insulin prescription, meal planning and daily exercise will help to further regulate your blood sugar. The important thing to remember is that this disease is manageable and it doesn’t have to mean being held back in life. The American Diabetes Association puts out a magazine called Diabetes Forecast that’s full of information, recipes, and fitness tips and there are many online communities you can join for advice and support.

Managing your insulin prescription might feel overwhelming at first, but the team of pharmacists at Alto will have your back, answering your questions and ensuring the seamless delivery of your insulin and other medications. 

Treatment for type 2 diabetes works a little differently for everyone. You may need to take oral medications or insulin injections, or you might be able to manage it with lifestyle changes alone. 

Oftentimes, treatment includes a mix of several oral medications and/or insulin. To minimize confusion over multiple prescriptions, the Alto app can help you easily manage everything in one place and set up automatic refills. Not to mention, our team of pharmacists will always be standing by to offer guidance. 

But whether you need a prescription or not, eating right and exercising will be extremely important parts of your life with type 2 diabetes. A healthy lifestyle will help keep your blood sugar stable, maintain healthy cholesterol levels, and control your blood pressure. The American Diabetes Association offers free resources that can help you get started, and you certainly won’t be alone. There are many millions of people currently living and thriving with type 2 diabetes around the world. An online community is a great place to start connecting.

A diabetes diagnosis can be daunting, but it never has to mean missing out on life. Remember, we’ll be here to help you understand your medications and set up a delivery plan that fits into your schedule. 

Looking for a partner to help you manage your prescriptions? Our team is available to answer your questions from 6 am - 9 pm PT Monday - Friday, and 7 am - 6 pm PT on weekends; reach out by phone or in-app secure messaging.

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

We took the best parts of the software engineer interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients!

What to Expect When You Interview as a Software Engineer at Alto

Thank you so much for considering an interview at Alto! At Alto, we’ve devoted a considerable amount of time refining how we interview candidates for software engineering roles. As engineers, engineering managers, and recruiters at a rapidly growing company, this is a big part of our jobs and we want to get it right: for the candidate, for ourselves, and for the team. We took the best parts of the interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients. Let’s dive in!

What does a Software Engineer at Alto do?

First and foremost, Alto exists to serve our patients--whether that be via building products, or providing exemplary service. Engineers at Alto are empowered to go the extra mile to make an impact for our patients, medical providers, and amazing pharmacists and care professionals. We are organized into small mission-focused teams where you will be working closely with Product Managers, Designers, Data Analysts, Data Scientists, and our Care team. Alto Engineers enjoy this cross-functional, collaborative environment where everybody has a voice in the direction of the product and the team. Compared to other companies, we are more end-user focused in most of our teams, even those that work primarily on platform and infrastructure.

Our pragmatic focus on impact includes making sure that we fulfill our company value of Patients Come First. We have a strong culture of code reviews, testing, documentation, and knowledge sharing to ensure that the service consistently meets our patients’ and providers’ expectations for quality and reliability.

Developing a Predictive Interview Process to Reduce Unconscious Bias

We want our engineering team to look like our customers — and we strive to serve everybody. Our mission is to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it. In order to effectively carry out our mission, we believe our engineering team should reflect the rich diversity of our customers. Our engineers come from all backgrounds and took many varied paths to arrive here: self-taught, coding bootcamps, and top-tier universities. Prior experience ranges from none to decades at large public tech companies with many joining from other startups and consulting/contracting backgrounds. Reflecting this, we’ve put together an interview process that focuses on predicting job success over testing for rarely-used computer science knowledge and encourages hiring diversity of all kinds rather than filtering for a certain type of engineer.

Throughout the interview, we work on problems that are facing Alto today or that we’ve dealt with recently. Our interview questions rarely have a “right” answer, and if you are writing code, any language works. (We spend our time mostly in Javascript, Ruby, and Go.) Occasionally, you will have more than one interviewer in the session. This is likely because one interviewer is shadowing the other to train, get calibrated, and learn how to deliver and interpret the questions while minimizing bias.

This is a quick chat with a recruiter or a hiring manager to further expand on your experience, capabilities, and interests. Based on this, we’ll have a good idea for which team(s) you would be the best match.

This screen aims to validate your technical skills. You’ll be working in a networked IDE (like CoderPad) with an Altoid (what we call ourselves) to write and run code that addresses a typical problem that you might face at Alto. We’re looking for fluency in the language of your choice and some fundamental object-oriented programming design skills. 

This is based on a typical task that you might face at Alto - something like designing or interfacing with an API. You're welcome to use StackOverflow, Google, or any other resources at your disposal—including your interviewer! We’ll be observing how you understand the problem, communicate with your interviewer to develop requirements, and get to working and well-tested code. 

In this section, you’ll spend some time getting to know a problem we have faced. You’ll spend 10-30 minutes working on how to approach and optimize a challenge that impacts our business everyday, then show that you can translate that into working code.

This module varies depending on your experience and interests. For some folks, we dive deeper into software design and learn how you would break up a hypothetical application into core modules. For senior frontend developers, this might be an app architecture challenge. And for senior backend developers, we’ll address systems architecture with an eye toward scalability, observability, and technology choices. In every case, we’re looking closely at how you approached the problem, gathered requirements, and justified your decisions.

The Engineering Manager is trying to deeply understand who you are as an engineer and a person. What do you get excited about? What type of roles do you like taking on within a team or project? What is your career arc and how can you best advance that at Alto? The questions often asked are behavioral or hypothetical in nature, and we love to hear stories about your proudest accomplishments and challenges you’ve overcome.

“I had an amazing interview experience with Alto - although the recruiters were super busy, they made sure to accommodate my timeline," shares Jacinda Zhong, Software Engineer, Core Services at Alto.  "I was really pleased to find out that Alto asks questions based on the type of work I’d be doing - no obscure CS concepts, and questions centered around complex business logic that you’d encounter working at Alto. Before my onsite, my recruiter gave me a call to provide context on what they’d be asking. No gotchas and no surprises, plus lots of detail so that I could be prepared to do my best. So excited to be working here and contributing to a great mission!”

The interviewers get together promptly—we try to do it no later than the next day—to discuss next steps. Prior to our discussion, we individually assess your performance against a rubric that takes into account your level of experience and the requirements for the role.

There is rarely unanimity in the panel. Almost everybody at Alto was discussed in a panel where there were some mix of Yeses and Nos. Often, we ask ourselves questions like, “What is the candidate’s superpower?”, “What will they add to the team?”, and “For which open role are they the best match?” Our hardest decisions are the ones where we all agree that the candidate is somebody we want to work with but we don’t have exactly the right role.

Don’t be surprised if your interview is slightly different from what is described here. We’re constantly refining our process to get to better hiring decisions more quickly and with less bias with regular feedback from candidates, interviewers and recruiters. 

Have you had an interview experience that you thought was exceptional? Let us know at feedback@alto.com.