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A diagnosis of a chronic illness brings significant changes to many areas of life. While the journey of learning to live with a condition looks different for everyone, the importance of support is universal.

Support can and should take many different forms. New physical and mental health needs are both common when navigating a chronic condition, and there are resources to draw on for both facets of your wellness.

Finding Support After a Chronic Illness Diagnosis

A diagnosis of a chronic illness brings significant changes to many areas of life. While the journey of learning to live with a condition looks different for everyone, the importance of support is universal.

Support can and should take many different forms. New physical and mental health needs are both common when navigating a chronic condition, and there are resources to draw on for both facets of your wellness.

We encourage you to think broadly in building your support system, even when focusing more specifically on your physical or mental health. In the case of physical health, specialists like diabetes educators can supplement a provider’s care with more personalized guidance. And with mental health, different forms of support may be necessary to address the various ways that a diagnosis affects you individually as well as your relationships.

Here are some suggestions to help you build a strong support system after a chronic illness diagnosis.

Many chronic illnesses require medical care from a specialist with the expertise to address specific symptoms rather than a primary care physician. Medical specializations for chronic conditions include the following.

A pulmonologist specializes in the treatment of respiratory conditions including chronic obstructive pulmonary disease (COPD).

An endocrinologist specializes in the treatment of endocrine disorders including diabetes.

A rheumatologist specializes in the treatment of inflammatory autoimmune diseases including rheumatoid arthritis and lupus.

A gastroenterologist specializes in the treatment of digestive health conditions including celiac disease and inflammatory bowel disease.

A neurologist specializes in the treatment of diseases of the brain, spinal cord, and nervous system including dementia, Parkinson’s disease, and epilepsy.

Your primary care provider can help you make sure you’re seeing the right specialist for your diagnosis. In some cases, they may have the necessary expertise to treat your condition themselves. For example, if a primary care provider is board-certified in infectious diseases and internal medicine, they may be able to oversee antiretroviral therapy treatment for HIV.

There are many possible ways to look for a specialist. You can ask your primary care provider for referrals, contact your insurance company, or reach out to others you know with the same condition. If you don’t know many people affected by your illness, joining a support group can be a great way to build connections and get recommendations.

Many of the factors that people consider when looking for a primary care physician — communication style, for instance — are also relevant to finding a specialist for treatment of a chronic condition. How comfortable you feel around your provider can significantly affect your experience of living with an illness. Facing a diagnosis head-on requires you to feel informed, and to feel informed, you need an open dialogue with your medical team.

A provider’s background and training is particularly important when looking for a specialist, since treatment is often more complex. How many years they’ve been practicing can be an indicator of experience, but remember that it’s just one metric. Depending on your needs, you may be well served by working with a physician in the middle of their career.

Other factors that reflect a provider’s qualifications include research interests, and active involvement in research, and their affiliation with organizations related to their field. You may also consider where they completed residency and fellowship training — some hospitals and institutes are known for certain medical specialties.

Depending on your specific diagnosis, it may be important to look for a provider who is affiliated with a specific hospital. For example, more advanced COPD can cause flare-ups, or periods of intensified symptoms, which in some cases may require treatment in a hospital setting.

You may encounter treatment-related decisions that depend on personal preference. For example, some people who experience chronic pain as a result of their illness want to explore non-pharmacological options, or ways to manage pain without medication. If that’s of interest to you, look for a provider whose care philosophy aligns with your needs and views.

You may benefit from working with specialized healthcare professionals in addition to your medical team. Diabetes educators are professionally certified to coach individuals living with the condition. They offer support for numerous aspects of diabetes management, from insulin administration to insurance navigation and lifestyle changes.

Read What Does a Diabetes Educator Do and How Can They Help You?

Similarly, registered dietitian nutritionists who specialize in COPD can help you make dietary changes as part of treatment for the condition. (Since food affects your breathing, people with COPD are typically advised to consume more fats while reducing their intake of carbohydrates.)

Building a support system often involves asking for more help from your friends and family. Since stress management is part of navigating a chronic illness, look for opportunities to take responsibilities off of your plate. Communicate what you need as specifically as possible, and remember that people are ready to help.

You may find that you have less energy to focus on others. Prioritize relationships with supportive people who are sensitive to what you’re experiencing, and whom you want with you on this journey — it’s your decision who you share personal health details with.

Chronic illnesses can bring shifts in identity as you make changes to your routine and lean more heavily on others. Stress is common, too, as a diagnosis often comes with much uncertainty. For these reasons and others, your diagnosis may affect your mental health. In fact, some studies have found that living with a chronic condition increases a person’s risk of depression.

Therapy offers the support you need to process the emotional experience of a diagnosis. For many people, individual counseling provides a safe space to openly share their feelings and concerns related to illness. Many therapists have special training to support you in coping with a chronic illness, so look for this expertise as you search for the right practitioner.

If you have kids, a therapist can also support you in sharing your diagnosis with them in age-appropriate ways. If you are concerned about how your diagnosis has affected the entire family unit and your relationships, family and/or couples therapy may help you navigate the changes together.

There’s no substitute for support from those who have been in your shoes and faced the same challenges. Peer-led support groups give you the opportunity to express your feelings to people who have firsthand experience of your condition. They can also share the coping strategies they’ve found most helpful.

As a starting point, look for a nonprofit related to your specific diagnosis. Many organizations offer both in-person and virtual groups, so connecting with others is not confined to geography. 

One final component of a strong support system: a reliable pharmacy partner. Our pharmacists are here with information and answers, even during nights and weekends, and the Alto app gives you control and convenience in managing your medications, with auto refills, medication bundling, and custom dosing reminders.

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.

Last month, Alto celebrated the well-deserved promotions of many Altoids across the company. Among those promoted is Elnaz Moshfeghian, who is now Alto’s VP of Strategic Planning & Business Operations. Elnaz shares more about her new role, what she’s most excited about at Alto, and advice she has for those looking to make a career pivot.  

Catching up with Elnaz Moshfeghian, Alto’s new VP of Strategic Planning & Business Operations | Alto

Last month, Alto celebrated the well-deserved promotions of many Altoids across the company. Among those promoted is Elnaz Moshfeghian, who is now Alto’s VP of Strategic Planning & Business Operations.

Elnaz joined Alto in 2016 as a software engineer and when we last connected with her in 2020, she shared her thoughts on building a career in engineering. Since then, Elnaz has pivoted to a truly cross functional, strategy-focused role, where she applies learnings from her engineering experience with her ability to identify opportunities for growth. 

Below, Elnaz shares more about her new role, what she’s most excited about at Alto, and advice she has for those looking to make a career pivot.  

To start, congratulations on your new role! You joined Alto 6.5 years ago, and so much has changed both within the company and the industry at large. Can you tell me a little bit about your journey at Alto? 

I’ve always been attracted to problems that are cross functional and can be solved by bringing together different teams - pharmacists, technicians, logistics, dispatch, sales. I really enjoyed it as an engineer, given that when I joined there were no product managers. We all had to figure out what we were going to build and build it ourselves. I loved working with teams, which is why I pursued the manager track. I noticed pretty quickly that the most interesting and challenging problems rarely came down to technical decisions, but more-so to people and priorities. 

As I grew in my engineering career, and got to lead teams solving problems, I was always searching for how to expand my understanding and impact across the business. I had the opportunity to shift into a strategy and operations role, which allowed me to shadow the CEO and learn a great deal while also identifying the company’s key priorities, understanding how they're doing, and ensuring that they stay on track. The new role allows me to use everything I’ve learned over the last 6.5 years at the company while at the same time, learning a lot from a seasoned leader like Alicia on how to run a business. 

Your previous experience was in engineering, and you didn’t work in healthcare or pharma before joining Alto. What has been the biggest surprise to you since joining the company? 

There are a lot of different hands in healthcare; it's a really complex space and there’s a lot at stake. I’m always mystified by how hard it is to align different parties’ incentives to result in the right outcome for patients. It underscores the importance of Alto’s mission: to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it.

Tell me a little bit about your current role. What are you most excited by? 

I’ve loved seeing how the different pieces of the company connect, and being able to connect the dots when we’re missing something. It’s been really fun to see how a little bit of communication and collaboration can go a long way. I also love thinking about how what we’re doing today could set us up for bigger things in the future, and how we build today in a way that opens a lot of doors for us down the line. 

In your opinion, what are the biggest opportunities for the company? 

There’s always an opportunity to be excellent at the basics. Are we consistently providing the best patient experience? Are we getting patients the best price? Are we saving time for prescribers and their offices? Those are problems that we’ve been solving for a long time, but it just gets more interesting and challenging as we’ve gone into new markets and therapeutic areas, and worked with different kinds of patients and prescribers than we used to. 

Something that I’ve always been intrigued by is - how do you bring more transparency around pricing to prescribers and patients at the earliest possible time, so that they can make the best decisions? It’s something that’s really missing in the industry. It’s not easy to do, and that’s definitely something I think a lot about - ‘How can we be the one who makes it easy for prescribers to know what they’re about to send to the patient, and for the patient to know what their other options are?’ Because a lot of times, what your insurance may cover and what your doctor may prescribe may not always be the best option. There might be other options, and I think a lot of people don’t know to ask about that. 

What are the biggest challenges in the pharmaceutical industry today? 

I think there’s been a lot of great activity from different patient advocacy groups and state governments to regulate the worst of what’s happened in healthcare. It’s been cool to see that take shape over the last five years. The challenge is that it’s very hard to write legislation and force some of these things, and so I’ve honestly gotten more interested in how do you write the right laws and approach regulation in a way that allows innovation to still happen and thrive, and still protects the patient at the end of the day. 

Back to your engineering roots – what advice do you have for young engineers?

Given the state of venture capital and the industry, a lot of engineers are going to earlier-stage companies, because there’s a little bit more investment and activity happening. I had to figure that out along the way - how do you operate as the third engineer on the team? Being anyone in an early-stage, small company - and an engineer especially - comes with its own unique challenges and skills. It’s not something there’s a ton of resources around. There’s a lot of resources about how to start a company, but not a lot for how engineers can grow their career at a company at that stage. So, my advice would be to seek out mentorship and cross functional peers from whom you can learn and grow. 

You pivoted from engineering to operations and strategy. What advice do you have for someone looking to make a career change? 

As an engineer, I’ve really focused on making an impact, whether that’s through building a product or shaping the business with what I know, with tech being the backbone. And I think that’s something we don’t talk about as much in engineering - how do you take your skills and really channel them for maximum impact and better understanding of a business? And for people who want to start their own companies someday, taking the path I did could be really valuable. It allows you to be a better entrepreneur and a better contributor if you can see the connection between engineering choices and the systems you’re building, and how they impact your customer and other parties. 

The other piece is being comfortable with wearing a lot of different hats. It’s what really helped my growth, and it’s counter to a lot of advice you get. People will tell you to go deep, get specialized and go down one path. You need to, to some extent; I absolutely had to figure out how to be a better engineer and a better leader. But the most growth for me wasn’t necessarily to stay in engineering – it was to take a turn. Hopefully, I can give colleagues a little more confidence who want to take a turn and increase their impact, growth and learning. 

Catching up with Elnaz Moshfeghian, Alto’s new VP of Strategic Planning & Business Operations 

Alto Pharmacy is thrilled to announce that The Honorable Alex M. Azar II, the 24th Secretary of the U.S. Department of Health and Human Services, has joined our board of advisors. Read more here.

Alto Welcomes Secretary Alex M. Azar II to Board of Advisors

Alto Pharmacy is thrilled to announce that The Honorable Alex M. Azar II, the 24th Secretary of the U.S. Department of Health and Human Services, has joined our board of advisors. 

Since its formation in 2020, the Alto board of advisors has provided the company with strategic guidance and helped ensure that our efforts are both impactful and efficient, with services grounded in the highest standards of operational excellence. Secretary Azar brings deep experience in both public health and the private sector, and his personal commitment to the health of all Americans mirrors Alto’s mission and focus on patient outcomes. 

During his tenure as Secretary, Secretary Azar led the historic transformation of the healthcare system in the United States and the HHS’s response to the unprecedented COVID-19 pandemic. He was the architect of Operation Warp Speed, delivering COVID-19 vaccines and therapeutics in record time, and led a team of more than 85,000 employees. Among many other accomplishments, Secretary Azar drove efforts to reduce drug prices, increase private insurance options, bring transparency of price and quality information to healthcare, expand telehealth, enable healthcare provider collaborative care models and remove regulatory barriers to low-cost, high-quality care. 

He has also played significant roles on the global health stage and championing the U.S.’s global health security efforts, including representing the U.S. in the World Health Assembly, working with the WHO to end Ebola outbreaks in the Democratic Republic of the Congo, chairing the most active G7 health ministerial in history in 2020, and convening and leading western hemisphere coordinated efforts to assist with the Venezuelan refugee crisis.

In addition to his public sector work, Secretary Azar served for ten years at Eli Lilly and Company, including five years as president of Lilly USA, LLC, its largest affiliate. He serves on several corporate and advisory boards and is a part-time Adjunct Professor of Business and Senior Executive-in-Residence at the University of Miami Herbert Business School. 

“Alto is honored to welcome Secretary Alex M. Azar II to our board of advisors,” said Alicia Boler Davis, CEO of Alto Pharmacy. “Secretary Azar is one of the most tenured experts in public and private healthcare, and his career-long commitment to improving public health perfectly reflects our top founding value – to put patients first. We are grateful for his service and are excited to leverage his deep experience and learnings as we continue to grow.” 

“Alto’s commitment to its mission of fulfilling medicine’s true purpose — to improve quality of life — for everyone who needs it sets it apart from other pharmacies,” said Secretary Azar. “I’ve dedicated my career to developing solutions for providing and enhancing healthcare outcomes for all, and I look forward to working with the Alto team and the board of advisors to continue doing just that.

No industry is immune to burnout, including pharmacy. At many traditional retail pharmacies, individual pharmacists are often asked to do more than is possible on any given workday. Not only does this deprive talented and extensively trained health professionals of a manageable working environment, it deprives patients of the exceptional care they deserve.

pharmacists-spotlight-roni-hein

The better pharmacy model we’ve created at Alto makes life easier for everyone involved in the prescription process: patients, physicians, and pharmacists. And in restructuring how pharmacists work, we haven’t just separated fulfillment and patient care responsibilities into different roles — we’ve ensured that there’s ample support for each specialization, as there should be in any profession.

To wrap up our series of pharmacist profiles in celebration of American Pharmacist Month, we spoke to Roni Hein, a patient care pharmacist lead who takes care of her team so that they can in turn care for patients.

What motivated you to pursue a career in pharmacy?

It all began with my high school and college job at Target. I interacted a lot with the pharmacy team while working in the health and beauty section and eventually moved into that department.

I never expected it to be more than a college job, but it turned into the beginning of my professional path. As I worked there, I was able to see the impact pharmacists made in customers’ lives each day. It really struck me that in many communities, including mine, pharmacists were the most accessible healthcare providers. That accessibility is so impactful on a person’s well-being.

What challenges have you encountered as a pharmacist?

Limited time and isolation behind the counter, without question. In retail pharmacy, more and more responsibilities were added to my job description, with fewer resources to accomplish them.

All pharmacists value the personal connections we make with patients. I think many of us would say that making an impact through patient counseling is the best part of our day, but that is often what gets lost when pharmacists are asked to do more. Our primary driver for entering the profession is the first thing to go. I found a very refreshing change at Alto.

Everyone at Alto, no matter their department or role, has the same shared goal of improving patient lives by transforming the pharmacy model. As a patient care pharmacist lead, I do that by supporting my people. I create the space for our pharmacists to do their best work. They are able to have better interactions with patients because they are taken care of.

The pandemic has been a trying time for many companies and teams, including mine. I am constantly looking for new ways to ward off burnout and maintain a sense of camaraderie, not only for the pharmacists I manage, but for the benefit of our customers as well.

The individual locations of many retail pharmacies can feel very separate from each other. Each one often serves a single population.

The centralization of Alto’s patient care team is a contrast to that model. We have a cohesive, unified team serving all patients. That means there’s a depth of resources available to each pharmacist, which is also really important for retaining great talent.

Our pharmacists have a great support system in their colleagues. There’s other smart, driven pharmacists to bounce ideas off of. Unfortunately, you don’t always get that in our profession.

It also means that you don’t have to worry about anything falling through the cracks if something comes up outside of work. It's a game changer to be able to take time to grieve a loved one or to care for your child if they’re sick while knowing that your patients are still in expert hands. I never had that in retail pharmacy.

Finally, what is one thing people would be surprised to know about life as a pharmacist?

At a tech-oriented pharmacy like Alto where there’s so much innovation, you’re constantly thinking of new and creative ways to problem solve. It’s challenging in the best possible way. There isn’t a day when I don’t have to put my critical thinking skills to use.

This is part of a series of pharmacist profiles to recognize American Pharmacist Month 2022. Meet the other pharmacists featured in this series: patient care pharmacist Travis Allison, specialty patient care pharmacist Gabrielle Kaplan, and medication therapy management pharmacist Wei-Lin Chang.

National Pharmacists Month Spotlight: Roni Hein

For many Americans living with a chronic health condition, prescription medications are necessary to manage symptoms and prevent complications. But following a treatment plan can be easier said than done. There are many considerations involved, from managing medication interactions and side effects to staying on track with related testing and follow-up appointments. And of the 66% of U.S. adults who are prescribed medication, only half take their medication as prescribed.

National Pharmacists Month Spotlight: Wei-Lin Chang

At Alto, medication therapy management pharmacists like Wei-Lin Chang help patients navigate all the complexities of managing a chronic disease. As part of our coverage of American Pharmacist Month 2022, we spoke to Wei-Lin about her professional path, the challenges of retail pharmacy, and the importance of medication education.

I honestly didn’t know what I wanted to do when I first entered college. My parents encouraged me to pursue a career in healthcare, but I knew I was a bit too squeamish around needles to become a doctor or nurse.

I took a chemistry class that I really enjoyed and decided to do all the pharmacy prereqs. I then did an internship with the head of pharmacy at Cook County Hospital in Chicago. Through that experience, I saw firsthand that pharmacists were a critical liaison between patients and doctors, with so much valuable information about medication strength, directions, dosing, and administration.

After that, I pretty much knew that pharmacy was for me. I’ve been practicing since 2002.

Before Alto, I worked in traditional retail pharmacy. In that setting, you’re so busy as a pharmacist — it’s one customer after another after another.

I worked both daytime and night shifts, and it was during the night shift, when the store was much more quiet, that I could really counsel patients without feeling so pressed for time. During the day, I simply didn’t have the free minutes to always answer patient questions or give recommendations.

Another challenge I faced was the perception of our profession. At the beginning of my career, in the early 2000s, many people I encountered didn’t know a pharmacist did much beyond putting pills in bottles and handing them off to customers. Not only did this lead to frustration from my customers, who would wonder what we were doing and why it was taking so long, it led to missed opportunities to more actively participate in a patient’s health journey. 

More medication education for patients is an urgent need within American healthcare. People taking multiple medications have to be mindful of potential side effects and medication interactions.

The growing field of medication therapy management is an opportunity for pharmacists to play an even bigger role in patient health, and I’m very proud to work for a company that prioritizes this particular area of pharmacy.

As a medication therapy management (MTM) pharmacist, I contact patients who take multiple medications — often multiple heart medications — and review their entire regimen over the phone. I make sure that they understand the purpose of each medication they’re taking and are on track with related testing.

For example, it’s important to get your liver function checked every 6-12 months if you’re taking cholesterol-lowering medications that are processed by the liver, or to get your A1C levels checked every 3-6 months if you’re taking diabetes medication.

We also discuss side effects, interactions, when to take medication, and what food to take it with. Too often, there isn’t the space for these conversations between pharmacists and patients, but they are so essential to a patient’s overall health. 

I love our pharmacy specializations. It’s unique to have a team that focuses solely on patients and another team that focuses on fulfillment. Not all pharmacies have a medication therapy management program, and it’s possible at Alto in part because of our smart allocation of resources.

Being able to use all of my time to focus on my core job functions is such a contrast to retail pharmacy, where you’re constantly bombarded from all sides at once.

As a pharmacist, what does “care” mean to you?

Care to me means going above and beyond for your patients and making sure all loose ends are tied. As an example, I recently initiated a transfer for one of the heart medications a patient takes. At Alto, we always complete every single step of the prescription transfer process on the patient’s behalf. He was so appreciative, and when I got off the phone, I could tell from his voice that he was smiling ear to ear. That’s the experience I want all of my patients to have.

This is part of a series of pharmacist profiles to recognize American Pharmacist Month 2022. To keep the Pharmacist Month celebrations going, meet patient care pharmacist Travis Allison and specialty patient care pharmacist Gabrielle Kaplan.

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. Their role has become more expansive than ever, and many people don’t realize just how integral they are to a patient’s health and well-being.

National Pharmacists Month Spotlight: Travis Allison

At Alto, fulfillment pharmacists focus on dispensing medication — ensuring that the entire process is carefully monitored every step of the way — while patient advocacy pharmacists tackle anything related to a patient’s wellness, from provider communication and insurance coordination to guidance on managing chronic health conditions.

These specializations have opened up entirely new possibilities for the patient-pharmacist relationship at Alto. And this October, as we celebrate American Pharmacist Month, we’re spotlighting a few of the extraordinary Alto pharmacists who focus on patient advocacy.

To kick things off, we’re pleased to introduce Travis Allison, a patient care pharmacist based in Dallas, Texas.

I took the long and winding road here. I didn’t always know this was what I wanted to do. In college, I started off as an English major but had a change of heart after a semester or two. I went on to study agriculture, and those experiences made me believe that I could pursue a path grounded in science.

My childhood memories of visiting the pharmacist were always in the back of my mind. As a kid, I hated going to the doctor. When those dreaded appointments were over and done with, I knew I’d get to see a guy in a white coat who would give me something to feel better. I always saw pharmacists as a comfort in the often scary world of healthcare.

At any chain pharmacy — which is where I spent my career before Alto — pharmacists are inundated with so many tasks. It isn’t that these tasks are unrelated to pharmacy, but they interfere with our ability to deliver patient care.

On a typical day, I would give 100 Covid shots and fill 200 prescriptions by myself while also coordinating billing and calling doctors’ offices. We also had to think about corporate metrics. I was frequently asked to get more people signed up for text message alerts and hit specific quotas.

Patient care is always the priority, for any pharmacist, but the reality of my job made it extremely difficult, and often impossible, to give patients the time they deserved.

The first thing I noticed when I started at Alto were the specializations. We have many different team members to handle all the responsibilities that fall on a single person’s shoulders at a traditional retail pharmacy.

I’m a patient care pharmacist, which is distinct from fulfillment pharmacists who process prescriptions.

I review prescriptions for accuracy and initiate medication transfers, and I interact with both patients and doctors. I’m here to answer any questions a patient has about their medication.

In a way, I feel like I’m on the frontlines the same way that I was when I worked in a pharmacy chain. It’s all of what I liked about retail pharmacy without the distractions of retail. We’re able to practice our most important functions as pharmacists without the noise.

We’re utilizing technology in a way no other pharmacy does, which allows us to communicate with patients and providers in so many different ways — without having to rush through interactions.

And the wheels of change turn much more quickly at a tech-oriented company than they do at a massive corporation. At my previous job, you could have conversations all day about what improvements were needed, but nothing ever happened. Alto was founded by software engineers, and we’re able to easily make changes in real time.

As a digital pharmacy, we serve so many patients that only we can serve. I talk to many who are homebound without a caretaker. Because of Alto’s model, I’m able to communicate with them, and we’re often their only point of contact within the healthcare system. I don’t know of another way these patients could get pharmacy care.

The digital model also allows us to get a broader view of healthcare, and to make an impact on a larger scale. Alto was one of few places where New Yorkers could get the Covid medication Paxlovid when it was first introduced.

It was incredible to be sitting here in Texas, getting prescriptions out in New York City just as a new variant came out that was really devastating to the city. At no other pharmacy would I have been able to help out my neighbors in New York.

Those moments where you can tell in a patient’s voice that you seriously helped them. To me, that’s an indication of how well I’m doing my job, much more so than the number of prescriptions processed or dollars generated.

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.

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

Meet the Newest Members of our Advisory Board | Alto Pharmacy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meet the Newest Members of Our Advisory Board

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Why We Switched to React Query for Managing Server State

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Below, we’ll dive into how we’re using React Query at Alto to solve these problems and achieve separation of client and server state.

The Old Way: Fetch Server Data and Store It in State

Historically, we would fetch data and set the response in our React component state.

fetchUser(params) {
 this.setState({ isLoading: true });
 
 return getUser(params)
   .then(({ data }) => {
     this.setState({
       isLoading: false,
       user: data.user,
     });
   })
   .catch(() => {
     toaster.toast({ title: 'Something went wrong...' });
     this.setState({ isLoading: false });
   });
}

To make that data accessible from other components, we’d set that data in the global Redux store. This works fine, except that you have to manage your own loading state, the logic for when and when not to make the request, updating the store when mutating data on the server, and knowing when data is stale.

The React Query Way: Fetch and Cache Server Data

With React Query, fetching data and using that data is more declarative.

const { data, error, isLoading } = useQuery(
 // This is our Query Key, which is unique per query so that React
 // Query can manage the cache for us.
 ['user', { userId }],
 
 // This is our Query Function that actually does the data fetching.
 // We can use anything we want: built-in fetch, axios, etc.
 fetchUser({ userId }),
 
 // This query will not execute until the userId exists.
 { enabled: !!userId },
);

Here, we define our query for a user with a Query Key and a Query Function. The Query Key is unique per query, so React Query can manage our cache for us, and if any part of the Query Key changes, the query will automatically fetch new data. In this example, if the user ID changes, the query will fetch new data for that specific user and store that data in the cache.

Naming is hard, but caching is harder. React Query gives us caching of server data out of the box with cache invalidation and request deduping. If we use this same query with the same Query Key in another component, it'll check the cache: if the data is already there, React Query will simply return it, avoiding extra network requests!

Additionally, useQuery runs wherever you use it — no more fetching data when a component mounts. You just use the query and display the data when it’s ready. The cherry on top? The query returns status updates by default, so we don’t need to store isLoading in component state all the time.

Three Optimizations We Get With React Query

When we rebuilt Alto Connect, our web app for healthcare providers, we found impactful benefits in using React Query to help us manage server state instead of using Redux. Alto Connect provides instant access to patient and prescription information and enables messaging with the pharmacy. Because healthcare providers need to quickly switch between patients and clinics, caching data is important to provide a delightfully fast experience. Apart from the cache, what other optimizations do we get by using React Query? Below are a few that helped us.

Once we’ve queried for some data, it gets entered into our cache, so we can utilize that cached data when using the same query in a different component or when fetching new data for a stale query in the background.

React Query is configured with aggressive but sane defaults and considers cached data as stale. Stale queries will always query for new data when the following criteria are met:

The query is optionally configured with a refetch interval

The fetching for new data when the browser window or tab is refocused is especially useful because the healthcare providers using Alto Connect often switch between multiple browser tabs. If there’s an update to a task, status, or message while they’re checking a patient’s medical chart, it will be immediately reflected in the UI when they come back to Alto Connect.

We also set a refetch interval for our queries involving messages. In the old app, we used WebSockets to enable real-time messaging. Although it’s possible to integrate WebSockets with React Query, we opted for a polling solution instead. Because our app isn’t a real-time messaging application, and we don’t need messages to show up immediately, we set a refetch interval on our messages query to poll for new messages every 30 seconds.

const { data, error, isLoading } = useQuery(
 ['user', { userId }, 'messages'],
 fetchMessages({ userId }),
 {
   // This query is disabled from automatically running if we don’t have a userId
   enabled: !!userId,
 
   // Refetch every 30 seconds
   refetchInterval: 30000,
 
   // Continue to refetch while the tab/window is in the background
   refetchIntervalInBackground: true,
 },
);

This is where the enabled option, which disables a query when it evaluates to false, is particularly powerful. We can pause polling for messages if we route to another page and we know that we won’t make any unnecessary requests if there isn’t a valid userId. We don’t have to worry about closing any socket connections or manually clearing an interval.

Most web apps have some sort of navigation menu, and if you already measure or understand your user behavior, you can prefetch data before users even navigate to a different page. Custom hooks makes it easy to expose a function to prefetch data:

export const usePrefetchUsers = () => {
 const queryClient = useQueryClient();
 const prefetchUsers = async () => {
   await queryClient.prefetchQuery(
     ['users'],
     fetchUsers,
   );
 };
 
 return { prefetchUsers };
};

Blog

Finding Support After a Chronic Illness Diagnosis

Catching up with Elnaz Moshfeghian, Alto’s new VP of Strategic Planning & Business Operations

Alto Welcomes Secretary Alex M. Azar II to Board of Advisors

National Pharmacists Month Spotlight: Roni Hein

National Pharmacists Month Spotlight: Wei-Lin Chang

National Pharmacists Month Spotlight: Travis Allison

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

Meet the Newest Members of Our Advisory Board

Why We Switched to React Query for Managing Server State

Two Engineering Interns Weigh In: What to Expect From Your Alto Internship

Five Black Healthcare Leaders to Celebrate

Developing Robust Authentication Using Rails, Omniauth, and Okta

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