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At Alto, we’re obsessed withour missionto improve quality of life for everyone who needs the help of medicine. Our mission guides us in all we do and every decision we make. 

Services that reduce travel and encourage social distancing are now more essential than ever, not only for vulnerable populations but all of us as members of our communities. Alto’s free same-day doorstep delivery ensures you have safe and reliable access to medications in this time of uncertainty. 

Hear first-hand from members of the Alto technology teams.

Alto / Blog

Managing your health during the pandemic is a long game. Here are five important heart health strategies to put into play during the COVID-19 pandemic.

Your Heart Health Playbook During COVID-19

What We Know about Heart Health and COVID-19

We mostly hear about how COVID-19 affects the lungs. But any serious viral infection can put stress on the heart by forcing it to work faster and harder as the body mobilizes to defend itself. Even more troubling, COVID-19 infection can cause blood clots in the heart’s arteries or attack and weaken the heart muscle itself. 

Anyone who is already managing high blood pressure or heart disease should take the potential for damage to their cardiovascular system seriously. Just don’t let vigilance and caution spiral into fear. While the gravity of the link between COVID-19 and cardiovascular health should not be understated, there are proactive ways you can support your heart and protect yourself from infection. 

Remember—managing your health during the pandemic is a long game. It’s crucial that you continue to take your medications as prescribed and receive necessary medical care. With this in mind, here are five important heart health strategies to put into play during the COVID-19 pandemic.

Five Heart Health Strategies During COVID-19

For months now you’ve been wearing a mask, social distancing, and avoiding crowded areas whenever possible. We know it hasn’t been easy, but keep it up. According to Penn Medicine cardiologist Helene Glassberg, MD, “The number one thing is to continue what you're doing, which is staying at home when possible, practicing safe distancing, and seeking medical attention if you're having problems.” Dr. Glassberg also recommends exercising caution as states experiment with loosening restrictions, advising, “Stay the course for as long as you can to stay well.”

There have been conflicting news reports involving some blood pressure medications and COVID-19. Despite what you might have read, don’t stop taking your medications without consulting your doctor. Not only is that never a good idea, but several recent studies indicate that there is no cause for concern when it comes to these medications. 

The confusion stemmed from the fact that two common classes of blood pressure drugs, known as angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), affect the same pathways in the body that the coronavirus takes to reach the lungs and the heart. Multiple types of both medications are available—commonly prescribed ACE inhibitors include lisinopril, captopril, and benazepril, while common ARBs include losartan, valsartan, and azilsartan. 

For a while, experts were unsure if these shared pathways meant that these medications might either help or harm people with the virus. According to Harvard Health, three different studies have found no evidence of harm for people infected with COVID-19 who continue to take ACE inhibitors and ARBs. While there is still research to be done, experts recommend that people already taking these medications should continue to do so. 

The same advice goes for any medications or lifestyle interventions that your doctor has prescribed. If anything, it is more important than ever to remain diligent with your cardiac care plan and stay in communication with your doctor. 

The prospect of sitting in the waiting room at the doctor’s office can be anxiety-provoking right now. While avoiding the doctor might feel like a safe choice in the short-term, skipping your appointments or ignoring symptoms could mean putting yourself at risk of serious health issues like heart attack and stroke, and increasing the danger of complications should you be exposed to COVID-19. 

Talk with your doctor about what safety measures have been put in place to protect you from COVID-19 exposure during your visits. Together you can assess the risks and create a plan to continue monitoring your blood pressure and heart health. Telehealth, which allows you to meet with your doctor via phone or video, may be an option and is often covered by insurance. 

If you pair virtual doctor visits with free hand-delivery of your prescription medications through Alto, you can avoid both the waiting room and long lines at the pharmacy. Transferring your prescriptions to Alto is easy and free—we’ll take care of the work for you. We’ll ask you to choose a convenient delivery window, and one of our couriers will bring your medications straight to your door at no additional cost. We can even provide completely contactless delivery if you prefer. 

Don’t Drop the Ball on Your Healthy Habits

Even though we’ve been at it for months, staying motivated to keep up healthy habits from home can still be a struggle. The stress and anxiety so many of us are feeling right now may affect our energy levels or cause us to lose interest in our usual activities. When facing distressing news reports or personal hardship, it’s tempting to self-soothe in various unhealthy ways. It’s okay to indulge sometimes, but try not to slide too far into less healthy coping mechanisms for the sake of your heart and your emotional well-being.

Cooking heart-healthy meals at home can boost your overall wellness and serve as a creative outlet. The American Heart Association created this resource for making smart shopping choices on a budget and offers a library of recipes to suit any skill level or craving. Staying active is equally important. If you find it difficult to work out from home, try thinking outside the box of what you’d normally consider fitness. For example, giving your kitchen a good scrub will get your heart rate up, and seeing your countertops sparkle will most likely relieve some stress. If you prefer to keep it simple, a brisk walk around your neighborhood is an effective choice that can help you feel connected to your community from a safe distance. 

Unfortunately, heart attacks and strokes don’t take a break when a global pandemic strikes. Do not delay getting emergency medical care because you fear going to the emergency room due to COVID-19. Heart disease is the number one cause of death in the United States, even now, and the hospital is the safest place you can be if you think you are experiencing a heart attack or stroke. Call 911 immediately at the first sign of trouble—the American Heart Association offers this resource for identifying a heart attack or stroke. We also recommend reading our article, “Heart Health Warning Signs to Watch Out For.” 

We are fully prepared to deliver your heart medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are stocked, our couriers are standing by, and our pharmacists are on-call to answer questions and assist with coordinating refills or requesting longer fills. We offer free, contactless delivery with every single prescription so you can rest easy at home knowing that everything you need is on its way. 

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.

We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive. 

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

At Alto, we are redefining the pharmacy experience which has been part of a very old, broken way that has fueled systemic racism. We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive.  Our team consists of committed and passionate individuals who champion to effect positive change on issues related to race, injustice and prejudice.

This passion for equality is what we strived for when we first set out to build a team with a broad representation of diversity. Our goal was to create a community that reflects an inclusive culture regardless of age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, or other dimensions of diversity. Yet even with the best of intentions we recognize that there is more work to be done to dismantle the systems and structures that fuel racism and inequity.

2020 has been a year like none other for so many.  HR professionals around the globe have stepped center stage to support our organizations, teams and communities in ways many of us could not imagine.  I wanted to write this post to share my personal journey on this topic while supporting others in capturing this moment.  I am a white gay cis man.  Many of my identities provide much privilege.  I am committed to educating myself. I am building an environment where our teams can push past their fears to learn and grow.

Read more about Why We Prioritize Diversity at Alto.  

In 2019 we initiated our focused DEI (Diversity Equity Inclusion) work with the goal of ensuring employees felt safe, and included, and ensuring that candidates and employees have equal access to opportunity for advancement in the organization. We learned a few things during the early days of this work including balancing listening while creating the right structure to move to action.  Fast forward to early 2020, in the midst of the global COVID-19 pandemic and the murder of Ahmaud Arbery, Breonna Taylor, Tony McDade, George Floyd, and Jacob Blake, we like many other organizations did not want another moment for action to pass by.

Read more about Alto’s Mission and Values. 

The week after George Floyd’s murder we hosted a series of listening sessions for Altoids.  We began them with a simple statement:  “We are holding this space for you.  Tell us how you are feeling.  Share your experiences.” The results were powerful moments of revelation, pain and heartbreak.  Black, Asian, Native and Latinx Altoids shared experiences of racism, sexism, and prejudice in their lives.  As a leadership team, we started to wake up to the enormity and urgency of the work we had ahead of us.

In reflecting on these tragic murders and Altoid voices, we realized we needed to expand the building blocks of our 2020/2021 DEI strategy. We recognized that we didn’t want to rely on the members of our underrepresented communities to lead us on this journey.  We do not expect underrepresented professionals to teach us, especially cis white men, about the history and experiences that led us to this moment. 

We made the decision to find a partner to help.  What struck me about Pathfinder and Trier Bryant, is their ability to push our thinking on this critical work while meeting us where we are (each one of us). Trier is a strategic leader with distinctive Tech, Wall Street, and military experience spanning across 15 years. Pathfinder has an unwavering commitment to advise leaders on how to create a more equitable, inclusive, and thriving culture to produce prosperous companies. I appreciate many aspects of Trier’s support including that she too is a Chief People Officer, she wears these shoes.  Given that experience plus Pathfinder’s work with clients like Equinox, Compass, SoundCloud, Gusto, and eBay, we gain perspective and lessons learned.

Our first half-day session with Trier focused on educating the group about the language of diversity (e.g. Is it okay to say Black? What makes up the LGBTQIA+ community?).  Next we spent time learning about key historical events starting from 1619 that have shaped our current society with respect to race, oppression, and white supremacy in America.  We watched videos displaying more covert forms of white supremacy [see Ellen Tuzzelo’s Pyramid of White Supremacy]. 

These are actions I could recognize in myself (i.e. not challenging racist jokes when told by my family members, not always believing the stories of Black victims).  I felt sadness and shame. Sharing these feelings and our part in the current state of our nation is an important step. We took time to process and walked away with an epiphany.  

Over the past decades, America and specifically Corporate America lulled itself into thinking that we’ve been fighting bias.  Our aim up until this moment was to reduce or eliminate bias.  We were wrong.   Our fight, our work is to eliminate racism and white supremacy in America. This work is neither a marathon nor a sprint; we’re committed to doing this work all our lives.   

With that realization in mind we got more specific about what diversity meant to us and where we wanted to focus our teams at Alto. Diversity by nature is very broad and inclusive. We used individual characteristics, experiences, and abilities consistent with our values and mission that includes but is not limited to:

*Sexual Orientation and language abilities will begin to be captured with Workday, our new HR system.

As a part of the above education, we learned that while we all have various identities and intersections that represent our Altoids, intersectionality is a term that must be clearly understood to comprehend unique modes of discrimination and privilege that occur in the workplace.  

Identity - the fact of being who or what a person is; affinity (i.e. Hispanic/Latinx, Black, Male, Female, Nonbinary) 

Intersections - a point at which two or more identities  intersect (i.e. Hispanic/Latinx Gay Male, Black Heterosexual Female)

Intersectionality -  the cumulative way in which the effects of multiple forms of self-identifications intersect, overlap, or combine to create unique modes of discrimination and privilege; intersectionality identifies advantages and disadvantages that are felt by people due to a combination of factors

While Alto recognizes a broad and inclusive definition for diversity of various identities, there are strategic priorities for underrepresented groups at the company. After benchmarking current tech and health care demographics, we decided to focus our DEI work for Altoids including our leadership, managers and independent contractors on the following underrepresented groups at Alto: 

Women in STEM (Science Technology Engineering Math)

The following month we read So You Want to Talk about Race by Ijeoma Oluo. What an incredible read! This engaged us in thinking about and naming our privilege.  In the next half-day session with Trier, we discussed the book to name our privilege and explored how it influenced our personal and professional development.  

We learned several lessons from Ijeoma and Trier including that we’re going to make mistakes and say the wrong thing; that is part of the journey yet we still must do the work.  Also that microaggressions are as damaging as overt racism and we must do better at calling these detrimental behaviors out everyday. 

Lastly, non-white people fear retaliation most when the topic of racism and prejudice comes up; we must create a space for everyone’s voices and perspectives to not only be heard but respected.

As I reflected on our second half-day session together, I saw the journey for our leadership team through four stages.

Stage 1: Self-Awareness-doing the personal work regarding racism and privilege

Stage 2: Awakening-acknowledgement of role of racism, privilege, and gressions,; doing the work in our professional life

Stage 3: Empowering-identifying the work to be done with our team, team members and building more inclusion on our teams

Stage 4: Advocating-taking our roles as a senior leaders at Alto to change behaviors and lead change at the company and our communities 

For the last round of workshops we split up our senior leaders into smaller groups so that we could focus on the work needed to be done with each of their teams.  In these sessions, we learned more about identities.  How do we identify?  What do we learn and acknowledge about our team members identities?  We discussed specific examples of how intersectionality shows up in the workplace and the role it places in each other’s experiences.  This pivot allowed us to move into Stage 3.

As we embarked on taking this work to our team, we felt more prepared and comfortable because of the time spent educating, processing and doing our own work ahead of time. This allowed each of us to live one of our core values “start with empathy.” Being empathetic is hard when you haven’t done your own work.

As a result of all the foundational work we’d done as individuals, as a team and as a company, in July, our leadership team committed to a bolder, crisper DEI plan that includes four strategies with clear goals:

Hire - ensure we have diverse teams and insure all are valued

Include - increase inclusion and community 

Develop - educate our leadership team and all Altoids

Invest - support initiatives with money and time  

This new DEI plan rallied the team and catalyzed us to make some significant changes with clear alignment, commitment and clarity around the problem we’re trying to solve. For example, one immediate change we made was to focus our executive search process on underrepresented talent. I’m excited to share that only a few months later (most searches take 6 months), we were able to hire several outstanding candidates from underrepresented backgrounds. 

Before, we had just been “hoping” for diversity and thus looking in all the wrong places.  Once hiring diverse talent  at the executive level became a critical mandate, that forced us to really seek the right kind of strategy. I’m excited to share some more of the significant changes we’ve made, over a series of posts over the next few months.

We are far from perfect.  We have work to do to meet our goals.  These are our first steps.

In January, we will share our first DEI Report including workforce demographics, success stories, lessons learned from 2020, and aspirational goals for 2021 and beyond.

We condemn the violence and systemic racism that has harmed marginalized communities, specifically Black communities, for far too long. At the same time, we commit to look inward and educate ourselves to continue to create safe spaces for Altoids and to act on what we learn. 

This will be a lifelong journey and we will continue to share updates on our progress. Our actions must be sustained and focused on keeping the momentum of enabling change now and for future generations. 

Last, personally this work is the most fulfilling of my career. There are days I am exhausted.  There are days I need help.  Yet there are many days I overflow with pride in our team.  I am most hopeful about the work ahead and seeing the early fruits of this work while challenging us each day to do more.

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.

In honor of National Diabetes Month, here are seven ways we can take action together to spread the word about diabetes prevention.

88 Million Reasons to Support National Diabetes Month

November is National Diabetes Month—a time to raise awareness about the diabetes epidemic that is quietly underway in our country. It’s a chance to come together and take action, not just for the one in ten Americans who have diabetes, but for the 88 million of us who are at high risk of developing it due to high blood sugar levels (a condition known as prediabetes). 

As you walk through your city or town today, consider that, statistically, one in three people you see has prediabetes and more than 80% don’t know they have it. These numbers may come as a shock, but there is hope that we can change them. By making certain lifestyle changes, those of us with prediabetes can significantly lower our risk of a type 2 diabetes diagnosis. 

Could you be one of the 88 million people in America with prediabetes? Don’t be afraid to learn about your risk—knowing where you stand will allow you to take control of your health. The CDC-led National Diabetes Prevention Program offers a free risk test and other helpful resources at doihaveprediabetes.org. If you determine that you’re at risk, talk to your doctor so you can assess your risk level and develop a prevention strategy together. 

Remember the “one in three” statistic and consider sharing this tool with your loved ones or even via your social media channels. Raising awareness is the best way to turn the tide on diabetes. 

The COVID-19 pandemic has placed a spotlight on the widespread inequities in our healthcare system, which contribute to higher risk levels and worse outcomes in underserved communities. Just like COVID-19, diabetes disproportionately affects minority and low-income Americans. According to the ADA, Americans of color are nearly twice as likely to have diabetes and related chronic diseases.

Equal access to health care is a human right—no matter your race, gender, income, sexual orientation, age, or education. We urge you to read the ADA’s Bill of Rights to know your rights and better understand the injustices that many communities are currently facing. Please also consider sharing this resource to help shine more light on a dire issue. 

If you feel inspired to make waves for change, contact your government representatives to advocate for affordable and accessible healthcare for everyone. The ADA has created this online resource to help you reach out to lawmakers in your area and ask them to support legislation designed to end health disparities during the COVID-19 pandemic—from expanding health insurance coverage to making insulin more affordable. You can also sign up as an ADA Advocate to stay informed about issues affecting people with diabetes and keep using your voice to create change. 

If you or someone you know has type 1 diabetes, you might also consider signing up to become an advocate for JDRF—a nonprofit funding research and advocating for policies to help people with type 1 diabetes (T1D). According to JDRF, “Advocates use the most powerful tools they have — their own personal stories — to communicate the financial, medical, and emotional costs of T1D to our nation's leaders.” 

From enlightening talks to a live cooking class, the American Diabetes Association (ADA) is hosting some amazing virtual events throughout the month. Ask questions, listen to inspiring stories, and learn tips that can help you live a healthier life. 

You’ll also find a slew of virtual events hosted by JDRF on their monthly calendar, including a holiday auction, various meet and greets, and a Q&A session with an endocrinologist. 

Healthy choices matter for all of us, regardless of our risk level. This is a great opportunity to work on a new habit throughout the month. Whether you decide to take a daily walk or experiment with healthy kitchen swaps like chickpea pasta or nut-based milk, pick an activity that you might actually enjoy and try your best to keep it going. 

The jury is still out on how long it takes to solidify a new habit, but one recent study found that it took an average of 66 days before participants felt that new habits like eating fruit at lunch or running for 15 minutes became automatic. Of course, the actual time will vary by person and the perceived effort of the new activity. But the study found that daily repetition during the first few weeks was the key to making the new habits stick. 

If you’re currently living with diabetes, use this month as an annual reminder to recommit to your treatment plan. Taking medications as prescribed and keeping up a healthy lifestyle, including proper nutrition and exercise, is an essential part of reducing the impact of diabetes on your long-term health and well-being. 

And if you’re among the 1.5 million people who were newly diagnosed with diabetes this year, we share some helpful tips for settling into your routine in “Managing Your New Diabetes Diagnosis.” 

Find the Best Pharmacy for Your Diabetes Care

Managing your monthly medications should never be a struggle. Our pharmacists are on-call to field medication queries and walk you through doses or injections. We can deliver whatever you need—including insulin, glucose monitors, test strips, and more—directly to your door for free. For more on how we can help, read “The Best Pharmacy for Diabetes Care.” 

Want to learn more about Alto? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone/text at 1-800-874-5881, or the app. 

This 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.

This fall, we had the opportunity to meet Tiffany Remington and her husband Caleb, who spoke to us about the importance of having a pharmacy partner they could rely on through their own infertility journey.

Fertility Patient Story: Tiffany Shares Her Experience with Alto

How One Couple Navigated Their Infertility Journey

Facing fertility issues can feel like entering completely unfamiliar territory. From deciding when and how to pursue treatment to navigating the ensuing procedures and medication protocols, uncertainties can surface at every turn. However, while no two journeys are completely alike, there is so much to be learned from the many hopeful parents who have traveled the various paths of infertility treatment before. 

This fall, we had the opportunity to meet Tiffany Remington and her husband Caleb, who spoke to us about the importance of having a pharmacy partner they could rely on through their own infertility journey. Read on to learn more about how the process unfolded in Tiffany’s own words and her advice for others going through a similar experience. 

My husband, Caleb, and I love to seek out adventure in almost everything we do. For the past two years, we’ve been living full-time in an RV that we renovated into the coziest home on wheels. Before pursuing our wild dreams of living tiny, we created a one-off event called The Greatest Wedding Ever Donated, where we turned our wedding into a gala and benefit concert and raised $207,000 for charity. 

So what’s next in our books? Starting a family. To our surprise, it took us a year and a half to start our journey of growing our family, and most of the waiting was out of our control. When we had our initial visit with our reproductive endocrinologist back in May of 2019, we thought things were going to happen fast—boom, bam, baby in the utero in one month. We quickly found out how intense the process is and how little we fully understood. All we knew was that we needed help. 

My husband was born with a condition called cystic fibrosis (CF), a genetic condition that creates a thick buildup of mucus in his lungs and other organs of his body. 98% of men with CF are also born infertile due to the absence or underdevelopment of the vas deferens (think of it as the highway for the sperm). After trying to conceive for two years on our own, we had a gut feeling that the lottery win for natural conception was not in the cards. We are a couple affected by male factor infertility.

After choosing a clinic, we had blood work done within the month. We then planned for Caleb’s microTESE, a surgical procedure to extract sperm from the seminiferous tubules of a male’s testes and epididymis. Unfortunately, that was round one of delays. We had to wait five months for an open spot for surgery. The initial disappointment rapidly turned into gratitude knowing that we had more time to fully wrap our head around this process, find a community for support, and educate ourselves in the decisions we would have to make along the way.

In February of 2020, we joyfully celebrated the eleven vials of sperm that were collected and were ready to start our IVF protocol. To ours and the world’s dismay, COVID-19 restrictions were put into place and our clinic shut down in March, just as we were about to begin. Due to Caleb’s health and the nature of the virus, we decided to move our IVF funds back to his medical emergency savings in case something happened. 

For five and a half months, we waited. We finally came to a place of comfort to move forward once our clinic allowed for new patient protocols to resume. We officially started our IVF stimulation protocol for egg retrieval at the beginning of August. After fifteen days of shots, we pulled the trigger and were able to produce seventeen beautiful mature eggs. Of the seventeen eggs, fourteen were fertilized, thirteen made it to Day 3 Blastocysts, four to Day 5 Blastocysts, and two to Day 6. We ended up with a total of six embryos that got sent off for PGS testing. A week later, we found out that of the six embryos, three came back genetically normal.

We wanted to keep the momentum going, so we opted to transfer our first frozen embryo as soon as possible. I had surgery to remove a couple of polyps and by the beginning of October, I was in the clear with a healed uterus, ready to welcome our baby home. With the transfer protocol moving rapidly, I knew I had to find a new pharmacy that I felt like I could rely on. 

During egg retrieval, I ordered from my clinic’s partnered pharmacy without realizing that I had much of a choice otherwise. My medication was delivered to the wrong address, and the idea that it might happen again stressed me out because timing is everything in this process! When speaking with some of my IVF friends, I kept hearing about Alto Pharmacy. I took a deep dive to see what all the “buzz” was about.

I could feel the grin stretch across my face when clicking enter on the URL. The website was already drawing me in. This is a pharmacy? Free delivery, advice, price investigation, and they work with your insurance? I’ve been managing my husband’s medication for years. I know first-hand how time-consuming all of the things that Alto provides can be—it’s a full-time job. This isn't just a pharmacy, it's a care team.

When I saw that Alto would take the burden off my shoulders, I was INSTANTLY sold. No need for spreadsheets, no need to play phone manager while connecting insurance and pharmacies, no need to Google down a rabbit hole. They would take care of all the details and that in itself is priceless.

I had my nurse place my next order with Alto and within the hour I had a text message to my phone prompting me to download the Alto app where I could manage deliveries and medications, connect with a pharmacist, and track my orders. Again, mind blown. An app? For a pharmacy? Can someone bring Alto their crown? One of the best parts is that the delivery windows were only a couple of hours—not like most other pharmacies where you have to wait the entire day to receive your medications. They also have one of their own courier team members HAND-deliver it to you.

Boutique service with savings—I couldn’t be a bigger fan. This whole IVF process can sometimes make you feel like a number. Alto is one of those companies doing it right by honoring you as a human. They show up in your texts. They show up in the app. They show up on the phone. I felt heard and fought for.

If you are walking through this (in)fertility process, or any medical journey for that matter, my advice is: don’t be afraid to advocate for yourself. Speaking as both a caretaker and patient, medicine is often routine and anonymous, and personalized care has not yet been perfected. Pharmacy choice, specifically, matters. Are they reliable? Do they advocate for you as a patient? Can they cut costs? What’s their customer service like? What are patient reviews? Do they deliver on time? You have a choice, even if the options aren’t clear at the start.

The team at Alto is ready to be your partner through it all, from your first cycle to your last. Questions about using Alto? Visit alto.com/fertility or give us a call at 1-800-874-5881. Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends. 

To connect with Tiffany and Caleb follow them on Instagram @ustheremingtons. 

Disclosure: Tiffany received medications at no cost from Alto Pharmacy in order to share her opinion about our services. The views expressed are solely her own. 

Fertility Patient Story: Tiffany Shares Her Experience with Alto 

We offer the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Navigating HIV Treatment and Prevention During COVID-19

Living with HIV during the COVID-19 pandemic

It’s been over six months since the first stay-at-home orders swept across the country, and we’re just beginning to replace widespread uncertainty about the coronavirus with real-world data. There’s still much we don’t know about how COVID-19 affects those living with HIV, but researchers are working quickly to glean insights from cases over the past months. 

Though our understanding is continually evolving and the data is limited, experts believe that people with HIV who are receiving treatment have the same risk for COVID-19 as the general population. We do know, however, that people with weakened immune systems are more likely to get severely sick from COVID-19, which underscores the already vital importance of preventing new HIV infections and ensuring access to treatment. 

If you are at risk of HIV infection or living with HIV, we encourage you to not put prevention or treatment on hold. It’s also crucial that you stick to the plan outlined by your doctor as closely as possible, especially by taking your medications correctly and on time. As your pharmacy, we’re here to help you overcome any challenges in maintaining your regimen that may arise. Let’s walk through the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Is COVID-19 illness more severe in people living with HIV?

As we mentioned, when HIV is being treated, it does not seem to increase the risk of infection or severe illness. Those who are living with HIV and not on treatment or virally suppressed, however, may be at greater risk of COVID-19 complications. Additionally, older people living with HIV and those with other underlying health conditions may also be at greater risk of serious illness from COVID-19. It’s important to take precautions to protect yourself from COVID-19 infection by following CDC guidelines, such as wearing a mask, social distancing, and washing hands and high-touch surfaces often. 

We know that people living with HIV are more vulnerable to respiratory infections when their HIV is not well managed. That’s because their weakened immune systems may be unprepared to deal with an invading virus. For this reason, it’s incredibly important to continue your antiretroviral treatment (ART) as prescribed. If you are having difficulty continuing your treatment for any reason, talk with your healthcare provider right away.

What additional precautions should people living with HIV take?

The most important actions you can take for your health are to continue your HIV treatment and avoid potential exposure to the coronavirus. Follow the preventative guidelines outlined by the CDC to protect yourself and others from getting sick. Additionally, you should take the following precautions:

Keep your regular medical appointments and discuss ways you can reduce your risk of exposure to COVID-19 during your visits. Use telehealth services whenever possible; your doctor can advise you on the remote options available to you.

Keep at least a 30-day supply of your HIV medications on hand as well as any other medications or supplies you need to manage your health. If possible, ask for a three-month supply and choose a pharmacy that offers home delivery to avoid spending time in close contact with others while standing in lines. (Alto’s couriers will hand-deliver your medications to your doorstep, so you never have to worry about mail delays either!)

People living with HIV are at a higher risk of serious flu-related complications, make sure all your vaccinations are up-to-date, especially your flu shot.

The CDC recommends maintaining a healthy diet, aiming for 8 hours of sleep every night, and taking steps to reduce stress. 

If you start to feel sick, especially if you have a dry cough, fever, fatigue, and/or a loss of smell or taste, stay at home and contact your doctor immediately so you can determine your next steps. You will need to self-isolate to avoid spreading the coronavirus to others as you await instructions from your doctor. For this reason, we strongly recommend having a plan in place for if you get sick, including keeping 30 days’ worth of medications, food, and other supplies on hand.

How can I get tested for HIV during the COVID-19 pandemic?

It’s as important as ever to know your HIV status. If you’re at risk for HIV, talk to your healthcare provider about your options for getting tested. The CDC has stressed the importance of continued access to HIV testing and encourages people who are at risk for HIV infection to get tested in ways that support social distancing and stay-at-home orders (when they are in place), such as self-testing when possible. They have created this resource that lists self-testing services by state. You can also find in-person testing locations here. 

I’ve lost my insurance. How can I continue to get my HIV medication?

As we face this public health crisis, record numbers of people are also losing their jobs and employer-based coverage. If you’re currently uninsured or cannot afford your out-of-pocket costs, there are resources that can help. HIV.gov puts out this list of toll-free helplines that can help you find programs and services in your state to lower your treatment costs. They also list a variety of federal resources here. 

The AIDS Drug Assistance Program (ADAP), which is part of the Ryan White HIV/AIDS Program was created to help cover the cost of HIV-related prescription medications for people who have limited or no prescription drug coverage. Eligibility may vary by state, so find out more by using the ADAP Directory to identify your local program. 

How can I continue to access PrEP during the COVID-19 pandemic?

If you are at risk of HIV exposure, protecting yourself needs to remain a top priority. PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. We explain more in our article, “All About PrEP for HIV Prevention.”

If you are already taking PrEP, talk to your provider about the possibility of telehealth options for the time being and see if you can get a prescription for a 90-day supply of PrEP. To find an in-person or online provider, visit one of the following websites:
PleasePrEPme.org
Greaterthan.org

If you need help paying for PrEP, there are assistance programs available that can cover the costs. PleasePrEPme.org maintains a comprehensive list of available resources here. 

What are some ways to cope with stress and anxiety right now?

It’s normal to experience heightened emotions during times of stress. And, unfortunately, some of the actions we are taking to protect ourselves, such as social distancing, can negatively impact our emotional well-being. Here are some ways you can protect your mental health and cope with the stress and uncertainty of the COVID-19 pandemic.

Unplug when you need to. It’s important to stay informed, however, the constant cycle of news reports and social media updates can become all-consuming and overwhelming. Take breaks from your devices when necessary and try to focus on reliable news sources and avoid social media accounts and websites that may be spreading rumors or false information.

Find soothing activities and practice them daily. Maybe you turn to a calming classic like meditation when you need to recharge or perhaps nothing makes you happier than whipping up a batch of chocolate chip cookies from scratch. Whatever helps you unwind is good for your emotional well-being and overall health. 

Stay on top of your health and wellness. Stress can disrupt your usual healthy habits. Try to move your body frequently, incorporate healthy foods, and get a full night’s sleep. You may not succeed every day and that’s okay. Just do your best to keep up your healthy habits most of the time. 

Seek help if you need it. If feelings of fear, anger, sadness, worry, or numbness interfere with your responsibilities for several days in a row or if you find yourself turning to unhealthy coping strategies like drugs or alcohol, please reach out for help. The CDC offers this list of free and confidential resources.

We are committed to ensuring you receive your HIV medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked, our couriers are ready, and our pharmacists can assist with coordinating early refills and longer fills. We offer free, contactless delivery, plus ongoing access to support and advice.  

Reach out to our HIV speciality team at 1 (800) 874-5881 (call/text) or send us a message through our mobile app. We’re available from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends.

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88 Million Reasons to Support National Diabetes Month

Fertility Patient Story: Tiffany Shares Her Experience with Alto

Navigating HIV Treatment and Prevention During COVID-19

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