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Blog | Alto Pharmacy

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories, last month. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

Meet Munashe Kaseke, Senior Director of Business Operations and Debut Author

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories, last month.

Munashe began the project nearly three years ago as a creative outlet and continued to develop this beautiful collection of short stories during her time at Alto. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

Can you tell us more about the book and what inspired you to write it? 

The book is titled Send Her Back and Other Stories. It's a short story collection featuring sixteen distinct Black women, all immigrants from Zimbabwe. It's an intimate, fresh telling of the immigrant experience of Black women in the United States. The stories are varied, awash with both the joys and challenges of discovering a new world.

My characters range from those who are unsure of themselves and struggling with various aspects of the immigration system, to those who are well established, thriving, and in control of their own destiny. I was inspired to write these stories because of not only my own experiences but also those of my friends and immigrant community. The publishing world lacks diversity, and as a Black Zimbabwean immigrant, I felt these stories deserved to be told.

Who did you write the book for and what do you hope people take away from it?  

I dedicated this book to immigrants, women, and people of color because I hoped they would feel seen in this collection. I also hope that those who don't identify with one or more of these categories become more empathetic from reading this book. Ultimately though, I write for myself first and foremost. I enjoy the process of world-building and character development. I believe the best writers initially write for an audience of one, and when they're satisfied with their work, then they can begin considering how to share it with the world. 

What did you learn when writing the book? 

I had a group of beta readers throughout the writing process and it was cool to learn — through these readers — that many of my characters’ particular struggles and joys are much more universal, reflecting the experiences of immigrants and people of color around the world.

I also learned that there are many aspects of the U.S. immigration system that I assume are common knowledge, as well as many immigrants’ struggle of belonging and search for identity. I was astonished to learn how much of this was new to my American friends.

I wrote the first story almost three years ago. I didn't intend for these stories to become a book —  I was simply writing about whatever was on my mind at the time, with no timeline to completion. After the fifth story, I noticed an emerging theme, and that's when I first considered that these works might belong in a collection. Editing was the longest part of the process. From developmental edits to copy edits, it probably took a good year and half to get these stories publishing-ready

How did working at Alto impact your writing process?

When you love your job, it fuels creativity outside of work. It's hard to be creative or passionate about a hobby when you're burned out. I'm certain that had I not been at a company and in a role that provided great work-life balance, there is no way I would've been able to dedicate my weekends and evenings to writing and editing.

Some of my biggest supporters have been Altoids. When I released the book, I received multiple messages from Altoids telling me what their favorite stories were. Both Matt and Jamie (our founders) have been incredibly supportive as well — from the time they first learned about my creative writing passion almost a year ago, they have cheered me on and checked in on the book’s progress. 

Anything else you'd like to leave us with? 

I hope that more Americans engage with multicultural and Own Voice fiction. This is such a rich space full of promising emerging voices that I believe will help shift the country's conscience for good. I challenge you to intentionally seek out and add a few books by diverse authors to your reading list every year — don't leave it to chance.

Munashe’s book is available here. Learn more about the author at munashekaseke.com.

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Endometriosis: A Leading and Treatable Cause of Female Infertility

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

The endometrium is the tissue that typically lines the lining of the uterus. Endometriosis occurs when this type of tissue grows outside of the uterus, most commonly in the ovaries, fallopian tubes, and lining of the pelvic cavity. It may also grow in the intestines, rectum, bladder, vagina, cervix, or vulva. In extremely rare cases, it may be found outside of the pelvic area.

Just like endometrial tissue that grows normally in the uterine lining, the abnormal tissue that characterizes endometriosis thickens and bleeds during each menstrual cycle. However, whereas normal endometrial tissue is shed with the cycle, the abnormal tissue cannot leave the body. This can lead to inflammation and scarring of the surrounding tissue, as well as adhesions that bind the pelvic organs to one another.

In cases of endometriosis where tissue grows in the ovaries, the condition may lead to the development of cysts in the ovaries.

There is a spectrum of severity of endometriosis cases, defined by the amount of excess tissue and resulting cysts, scar tissue, or adhesions. The level of pain, which varies by individual, does not always correlate to the stage or severity of the condition. Pain typically peaks during a menstrual period.

The specific causes of endometriosis have not been identified, but the medical community believes that the following factors may contribute to its development:

Retrograde or reverse menstruation, in which endometrial tissue flows backwards through the fallopian tubes and into the abdomen during a menstrual cycle

Transformation of the cells that line the inside of the abdomen into endometrial-like tissue as the result of hormone or immune factors

Transformation of embryonic cells into endometrial-like tissue during puberty as the result of hormone factors

Attachment of endometrial cells to an incision during surgical procedures such as a hysterectomy or c-section

Transport of endometrial cells to other parts of the body via blood vessels or lymphatic fluid

Issues with the immune system that keep the body from destroying abnormal endometrial tissue

In addition, the following risk factors are often linked to endometriosis:

Getting your first menstrual cycle at an early age

Having an abnormally short menstrual cycle (e.g., less than 21 days)

Abnormally heavy menstrual periods lasting beyond seven days

Other health conditions that prevent the flow of menstrual blood during a menstrual period

There is also evidence that endometriosis may have a genetic component. You may have a higher risk of developing it if you have a mother, sister, or aunt with the condition.

Common symptoms of endometriosis include:

Pain, especially severe menstrual cramps in the abdomen or lower back

Painful urination or bowel movements during menstrual periods

Gastrointestinal issues including diarrhea, constipation, and nausea

Endometriosis can look very different from one individual to another, with varying experiences of symptoms. In some cases, the condition may not be accompanied by any noticeable symptoms.

How endometriosis affects female fertility

Endometriosis is a leading cause of female infertility, as abnormal growth of endometrial tissue can block the fallopian tubes, preventing the fertilization of an egg. It accounts for 24-50% of all female infertility cases, and one-third to one-half of individuals with the condition experience difficulty conceiving.

In mild or moderate cases of endometriosis, surgery to remove adhesions, cysts, and scar tissue is all that is needed to restore fertility. In other cases, additional procedures or fertility treatment may be required.

Getting an accurate diagnosis is critical to effectively treating the condition. However, the diagnosis process can be lengthy, with multiple steps, as symptoms frequently overlap with those of ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome (IBS).

An evaluation for endometriosis begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

A transvaginal or abdominal ultrasound, which provides images of your reproductive organs to help your doctor identify cysts potentially related to endometriosis

A laparoscopy, a procedure that inserts a small camera through the abdomen with the goal of directly identifying endometrial tissue outside of the uterus. This is the only procedure that can definitively confirm a diagnosis of endometriosis.

Severe pain from endometriosis can affect daily activities, and there are a variety of pain relief options, including both medications and surgery. Your doctor will likely try non-surgical interventions as a starting point and recommend procedures if the condition does not respond to initial treatment.

The following treatments may be used to treat discomfort caused by endometriosis or related health issues:

Over-the-counter pain medication such as ibuprofen

Supplemental hormones including the male hormone androgen, which can regulate hormonal production or minimize fluctuation to prevent abnormal tissue growth

Hormonal birth control including pills, patches, and vaginal rings, which prevent abnormal tissue growth by decreasing fertility

Gonadotropin-releasing hormone (GnRH) agonists, which block the production of estrogen to prevent menstruation

If symptoms do not improve after the treatments above, your doctor may recommend surgery. In addition to its usage during the diagnosis process, a laparoscopy can remove abnormal endometrial-like tissue. 

A hysterectomy, which removes the uterus and cervix, is typically reserved for severe cases. The procedure permanently affects your fertility, and you will not be able to become pregnant after the procedure. It’s important to consult your doctor about your options as well as your reproductive goals before moving forward.

In vitro fertilization (IVF) — a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy — can help individuals experiencing endometriosis-related infertility conceive.

In cases where fallopian tubes are blocked or severe scar tissue is present, your doctor may recommend proceeding directly to IVF before trying to conceive naturally.

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

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

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

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.

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

Osteoporosis, Explained | Alto Pharmacy

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

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

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

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

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

Posture changes such as stooping or bending forward

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

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

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

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

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

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

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

Previous bariatric surgery or organ transplant

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other nutrients that promote bone health include:

Magnesium - found in whole grains and dark green leafy vegetables

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

Zinc - found in whole grains, poultry, and nuts

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

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

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

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

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

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

Avoid cleaning products that leave the floor slippery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and is characterized by a hormone imbalance. It can impact many areas of a woman’s health, including menstrual cycles, fertility, insulin levels, and risk of cardiovascular disease.

How Polycystic Ovary Syndrome (PCOS) Affects Fertility

Symptoms of PCOS can be treated through a combination of medications and lifestyle changes. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Polycystic ovary syndrome has three defining symptoms: high levels of male hormones, irregular menstrual cycles, and the development of cysts in the ovaries. These features overlap.

Many women with PCOS have higher levels of androgen hormones, which are responsible for the development of certain male characteristics. For those with PCOS, overproduction of androgens leads to irregular menstrual cycles, hair loss, extra growth of hair on the face and body, and acne.

The cysts that develop in the ovaries are small follicles containing an immature egg. Since these eggs do not reach maturity, ovulation — the release of a mature egg from the ovaries — does not occur. The absence of ovulation leads to further imbalance of hormones, as progesterone decreases.

PCOS is the leading cause of female infertility.

Polycystic ovary syndrome can develop at any age after puberty. It is estimated that 5-10% of women between the ages of 15-44 have the condition.

The specific causes of PCOS have not been identified, but the medical community believes that condition is the result of several intersecting factors: insulin resistance, higher levels of androgens, higher levels of inflammation, and an irregular menstrual cycle.

Some evidence suggests that PCOS may have a genetic component. You may have a higher risk of developing PCOS if you have a mother, sister, or aunt with the condition. Obesity is also a risk factor.

Common symptoms of polycystic ovary syndrome include:

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