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Our mission at Alto is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it.

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

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

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When the pandemic hit, we were thankful to already be in the position to make a meaningful difference for Alto’s working parents. Our Working Parents & Allies Employee Resource Group (ERG) was formed at the beginning of 2020. 

Supporting Working Parents at Alto

With the COVID-19 pandemic forcing the shutdown of schools, offices, and daycare programs this year, working parents have been expected to accomplish Herculean feats of focus. Many parents spend their waking hours with one eye on their computer screens and the other on their children, all while coordinating remote learning, nap times, and video conferences. 

Those who continue to work outside the home must navigate the unpredictable availability of childcare services. Anything from new shutdown orders to a caretaker forced to quarantine can mean a lapse in care. A recent study found that 33% of working parents had no access to childcare at all, a percentage twice as large as in pre-pandemic times. 

At Alto, we serve thousands of working parents, including many who are juggling caring for their children and aging parents. Just as we support them by delivering a better pharmacy experience, we also want to support the hundreds of heroic parents working at Alto and caring for our customers every day. 

ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive. 

“Now more than ever it’s important to uplift and advocate for parents,” shares co-lead and mother Lidia Valdez. “The parenting landscape has shifted dramatically in 2020 but with the continued sense of community at Alto we can lean on one another for advice and support.” 

For more on how Alto fosters an inclusive culture and company, we invite you to read Diversity at Alto. 

The Mission of Alto’s Parent & Allies ERG

Alto’s Working Parents & Allies ERG came into being just before the pandemic began placing unprecedented demands on parents. It aims to provide an inclusive space for parents and allies to discuss how they’re feeling, speak openly about the challenges they’re facing, and request what they need from Alto. The ERG also helps parents remain informed and up-to-date on the policies and programs that are in place to support them. 

While the ERG’s first initiatives have centered upon providing pandemic-related support—from child care services to remote learning opportunities—these initiatives will continue to grow and evolve along with the needs of working parents at Alto. 

It was quickly apparent that Alto’s working parents—like parents everywhere—were overwhelmed with trying to manage the sudden shift to full-time, in-home childcare and schooling. The ERG responded by launching forums co-hosted by parents and the ERG leadership committee. These support groups were designed to create a safe space for parents and allies to share how they felt amidst a return to virtual learning in the Fall. Following the discussions, we launched a pilot program to offer immediate, tangible support. 

We began by inviting parents to opt into a program facilitating childcare services through UrbanSitter—a site that connects parents with trusted caretakers from their local communities. Interested parents received a stipend to cover membership fees and in-home or remote care costs. Whether parents needed support during a video conference or last-minute care after finding out their child’s daycare was closed, UrbanSitter could provide some relief.

We also rolled out a program with Outschool—a marketplace of live, online classes for students ages three to eighteen. Participating parents could access five hours of classes per week for free, allowing their children to explore interests ranging from math and music to filmmaking, coding, painting, and writing. With over 50,000 classes available, Outschool helps parents focus by keeping their kids engaged with fun, enriching activities. In the words of one Alto parent, “I really enjoyed Outschool for my kids. It’s such a good help; they are engaged and learning new things. Both my children and I love it!”

In addition, parents that needed hardware support for at-home distance learning were provided laptops at no cost. 

After a few months, we asked parents to provide feedback on the pilot program. We found that 71% of parents participated in the program, and 47% felt that the resources had made a positive impact on their lives or increased their ability to be productive and engaged at work. We’ll use this feedback to continue initiatives that have made a difference in the lives of Alto’s working parents while introducing new programs that can provide further support. 

The ERG leadership team also identified opportunities that would spark joy and support parents outside of the Alto community. “Working remotely can often feel isolating so we wanted to create instances for parents and their children to be recognized,” notes co-lead and parent Sandy Obeji. “In addition, we knew it would be important to extend this acknowledgement beyond parents at Alto.“

In October, we hosted a Halloween costume contest aimed at encouraging fun and creativity. Alto parents were invited to share photos of their kids in costumes, and prizes were awarded for the most unique, scariest, and funniest getups. Both adults and kids participated in choosing the winners, arguably providing more fun than a night of trick-or-treating. 

We also coordinated a Holiday Giveback Program to raise money for supplies and gifts for children and families in need during the holiday season. Alto employees were able to donate items to seven organizations—one for each Alto pharmacy location—virtually with the help of You Give Goods. In the end, we exceeded our fundraising goal and Alto matched the total donation to help make the holidays a little brighter for families across the country. 

Initiatives like these are just the beginning, and the Working Parents & Allies ERG has been collecting feedback that will guide our planning for 2021. In addition to extending access to several of the resources mentioned above, we are also exploring workshops for parents centered around current issues and events. 

There are plenty of reasons to believe that parents are superheroes, but that doesn’t mean we can expect them to perform superhuman tasks. Alto’s Working Parents & Allies ERG was created to help parents find much-needed balance and support during a tremendously difficult time. We look forward to seeing the group grow, aiding ongoing and future initiatives, and continuing to foster a culture where everyone feels included, valued, and supported. 

Interested in learning more about the Working Parents & Allies ERG? Reach out to parents@alto.com. 

The Disproportionate Impact of HIV in America

It has been a year full of seismic shifts. A series of core-shaking events ranging from a global pandemic to an upwelling of the Black Lives Matter movement has exposed deeply entrenched inequities in our society. 

We need only look at the statistics emerging from the COVID-19 pandemic to see these inequities at work. According to the CDC, Americans who are Black, Hispanic/Latinx, American Indian, and Alaskan Native are nearly three times more likely to become infected with COVID-19 than white Americans and approximately five times more likely to be hospitalized due to infection. 

Rather than being an anomaly, studies have revealed a health gap between white Americans and Americans of color so wide that it has been named a public health crisis. This divide is perhaps most evident in the disproportionate impact of the HIV epidemic.

The Story of HIV, Told Through the Numbers

Advances in HIV treatment and prevention over the past several decades are reason to feel hopeful. The number of people infected with HIV each year has plummeted by more than two-thirds since the height of the epidemic in the 1980s, and we’ve dramatically transformed the outlook for those living with HIV. However, our efforts to combat the HIV epidemic have stalled in the face of a serious issue—HIV prevention and treatment are not accessible to everyone who needs them. 

According to the CDC, Black Americans are the most affected racial or ethnic group with a lifetime HIV risk of one in twenty for men and one in forty-eight for women (compared to an overall risk of one in ninety-nine for all Americans). Gay and bisexual Black men have been hit hardest of all: it’s estimated that if current infection rates continue, one in two will contract HIV in their lifetime. Gay and bisexual Hispanic/Latino men face a similarly distressing statistic, with an estimated one in four at risk of HIV infection. 

These numbers paint a bleak picture, yet Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, offers hope. “As alarming as these lifetime risk estimates are,” he says, “they are not a foregone conclusion. They are a call to action.”

There is a complex set of socioeconomic factors—such as income, housing, and occupation—that impact a person’s risk of contracting HIV and affect the quality of care they receive. In the United States, HIV infections are mainly concentrated in urban areas and among those of a lower socioeconomic status. 

Like COVID-19 and HIV, poverty rates in the United States reveal clear racial and ethnic disparities. The data shows that one in four Black Americans and Native Americans live in poverty and one in five Hispanics/Latinos. For white Americans, the number is one in ten. 

There are significant barriers to accessing quality healthcare for those living in poverty, including financial insecurity and fear of discrimination. Many services that help to decrease HIV transmission rates—such as prevention education, substance abuse counseling, STI treatment, and antiretroviral therapy (ART)—remain mostly out of reach for these communities. In this way, the people who are most vulnerable to HIV infection continue to face an ever-growing risk. 

An HIV diagnosis today is vastly different than it once was. With antiretroviral therapy (ART), a person living with HIV can suppress the virus and stop the progression of HIV disease. Not only will maintaining viral suppression help them stay healthy, but it also means they will have effectively no risk of transmitting HIV to others. 

For those at risk of infection, pre-exposure prophylaxis (PrEP), an HIV prevention method available by prescription, can virtually eliminate that risk. However, unless we ensure HIV prevention, testing, and treatment are widely available and affordable, we will continue to see tens of thousands of new infections year after year. 

Want to learn more about PrEP? We explain the basics in “All About PrEP for HIV Prevention.”

These are significant issues to tackle, but we can each do our part by talking with our doctors if we’ve never had an HIV test or if we think we may be at risk of infection. We can support organizations like NMAC and Black AIDS Institute that work to make HIV services more accessible to communities of color. And we can encourage our elected officials to help fight HIV through government funding and programs. 

Lastly, we should avoid perpetuating the fear and stigma that’s often associated with HIV. When we talk about HIV openly and neutrally, we help create a culture where everyone feels safe to seek testing and care. 

Looking for a supportive partner to help manage your HIV medications? We’re here for you. You can reach out and talk with an HIV specialist between 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881, or download the mobile app for secure messaging.

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

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

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

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

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

Read more about Why We Prioritize Diversity at Alto.  

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

Read more about Alto’s Mission and Values. 

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

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

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

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

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

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

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

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

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

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

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

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

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

Women in STEM (Science Technology Engineering Math)

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

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

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

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

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

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

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

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

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

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

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

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

Include - increase inclusion and community 

Develop - educate our leadership team and all Altoids

Invest - support initiatives with money and time  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Airbnb’s Former Head of Business Technology Joins Alto

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. Previously, Cat spent five years at AirBnB where she acted as the  Global Head of Business Technology during their worldwide growth and was pivotal in delivering exceptional technology experiences to employees. With this expertise, and over 20 years experience spanning startups to Fortune 500 Companies, we are excited to officially call her an Altoid! 

We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Welcome to Alto! What excites you most about recently joining the team? 

Thank you! I’ll start by sharing that I am excited by companies that have a strong mission. This was an important consideration for joining Airbnb.  When contemplating what was next, I knew that this was a primary driver for my next move.  Alto’s mission - to improve the quality of life for everyone - very much resonated with me. 

Aside from that, my conversations with Altoids during the hiring process reflected a sense of passion and humility that I found to be rare in a successful company. There is a culture of really intelligent, driven individuals here that are unpretentious about their accomplishments. 

Likewise, any time I evaluate an opportunity for growth, I assess the impact that I can have based on my experience. Given my background in consulting, startups, and Fortune 500 companies, I found Alto’s goals to be in line with my ability to improve efficiency and help IT mature into being viewed as a critical enabler to our business.

You were the Global Head of Business Technology (Products) at Airbnb for 5 years. How did this experience shape your outlook on strategic growth and what was the most important lesson that you learned? 

When I joined Airbnb the IT organization was in its infancy. We were present in 192 countries and yet there were only six people assigned to the global team.  It was imperative to create a global strategy quickly that would both enable the hyper-growth of the company and consider how to scale in a cost effective way.

I think the key takeaway is that IT is everywhere. It's a foundational layer supporting how everything functions. Thinking about IT early in a company’s lifecycle is essential, but above that you have to ensure everything is thought of from a scalable perspective. If we only build for right now there will inevitably be a technical rework later so making sure the IT services are both built for increased volume and still cost effective is important.

Can you share a little bit about your goals at Alto for the remainder of the year? 

Right now I’m very focused on what I would call core/foundational IT (network infrastructure, IT support function, etc.) -- essentially the programs that are the enablers for everyone. I’m also working closely with Alto’s Director of Security to ensure that we continue to protect our patients' data with the utmost level of reliability. 

Next year I’d love to start addressing  how IT can enable more business return on investment. For example, managing and implementing 3rd party applications. Typically, and this was the same at Airbnb, if everyone is going off and buying different, potentially duplicative, applications, we start to leave money on the table and can have disjointed data and compromise security. This is where IT starts to become a case for ROI and business benefit. 

I’ll actually contend that Alto is a forward thinking in recognizing the importance of IT. Because of this, I know I’ll be able to create positive benefits because we’ll be in front of the curve. At the end of the day, if we can grow in a thoughtful manner, we’ll arrive at a place where we’ll have a really high performing IT organization that contributes to the bottom line. 

You know, my motto is to “embrace the adventure.” I love spending time outdoors, whether hiking, skiing, or sailing, so it really resonates in my professional life as well. I feel excited about developing an IT strategy that will ensure high quality services both in our sites and remotely, protect our internal data, maximize productivity of our workforce, and ultimately contribute to the company mission of improving the quality of life for everyone.

The good news is, having done this before, I don’t think there’s anything that’s a surprise yet. During the interview process, I knew that this role would require another ground-up build and that it would require a strategic and thoughtful leader. Having said that, the results are always less about me and more about what the team has been able to do and how we have contributed to Alto’s success.

On that note, how would your prior teams describe you? 

I think, or hope, my team would say that I’m incredibly supportive in removing anything that is keeping them from being able to achieve maximum impact or create maximum value for the company. I define myself as authentic, trustworthy and driven -- and value those qualities in others. I definitely have a high bar for excellence and want my team to be successful at performing but at the same time, I’m also there to help when needed and support their professional development. 

Stylistically I’ve always been a leader where I kind of exist to support others and provide thought leadership. You are nothing without your team. To quote Steve Jobs, "It doesn't make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do." This philosophy is one that has always resonated with me. 

How do you feel about technology changing our work culture given the current climate of COVID-19? 

Alto is the first job where I joined having never met a single team member in person. It’s definitely changed things up but I’m pretty comfortable with it at this point. Looking forward though, I think it’s important to consider how we can recreate the “magic” that happens in person when a number of our workforce is remote. 

COVID highlighted the significance of innovative IT related to remote work and collaboration that is essential for everyone. That area of creativity is where I think IT will fundamentally shift how we continue to work and communicate with one another in what may be an increasingly remote workforce. 

Are you working on any passion projects outside of Alto at the moment? 

Yes! I’m very passionate about animals and am currently looking to rescue another dog. Aside from that, I’m recently new to the Tahoe, CA, area so hope to become more embedded in community volunteering. 

My other personal passion project is actually an overhaul remodel on our Tahoe house which has required a fair amount of architecture and engineering for my husband and myself. It’s a fun project that keeps us constantly engaged with one another. 

What would you say to someone interested in joining the Alto team, specifically in a technology driven role? 

Just do it, it’s an amazing opportunity! I believe so strongly in what Alto is doing. If you ever have an opportunity to work for a company that is founder-led you should make it happen. There is a palpable passion that resonates throughout a company when the founders are present. It’s an experience worth doing because it creates a belief and excitement around the company that might not happen otherwise. 

For more information on Scott, or to connect with her directly, reach out via LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers. 

Airbnb’s Former Head of Business Technology Joins Alto 

In honor of National Coming Out day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PreP, to learn about his own personal experience and his advice for others on coming out.

Coming Out with Pride: Nicholas Satow Shares His Story

This year marks the 32nd anniversary of National Coming Out Day, a time to support lesbian, gay, bisexual, queer, and transexual individuals. In honor of this awareness day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PrEP, to learn about his own personal experience and his advice for others on coming out. ERG’s are voluntary, employee-led groups that foster a diverse, inclusive workplace aligned with organizational mission, values, goals, business practices, and objectives.

Q: Tell us a little about your coming out experience. When did it happen and who did you first tell? 

A: My coming out story starts with the story of my best friend. We met in third grade and were just 15-years-old when she came out to me. She was a star basketball player and met a girl from an opposing high school team 45 miles away. We quickly turned 16, and without our parents’ knowledge, we were driving 90 miles round trip every weekend to go see her girlfriend and hang out with a group of kids who didn’t know anyone from our school district. The 45 miles of distance made her feel safe from our friends and family finding out about her double life.

Leading a double life and constantly hiding our whereabouts started to wear on us. Especially for her after family and friends started becoming suspicious. Who is this girl you’re always on the phone with? Why are there so many miles on your car? Where are you going? Her fear of being outed or disowned started to build as rumors began to circulate between friends and family.

It was a Saturday night, and we were halfway through our 45 mile drive home. She broke down in tears and started to share terrifying thoughts she’d been having. She said she couldn’t take the pressure of the double life anymore and the rumors circulating at school. She felt extremely overwhelmed, isolated, and scared. Thoughts of teenage suicide and stories I had heard of queer teens taking their own lives started to consume my mind. Even though I wasn’t ready to come out of the closet yet, I knew in that moment my friend needed me more than ever. I felt responsible for her loneliness and selfish for making her go through this journey alone. She said, “I can’t take this anymore. I can’t live like this,” Staring at the road ahead, I said, “You need to stay strong. You make me strong.” I turned and looked at her and said, “I’m gay, too.” This was the first time I said those words out loud. It was terrifying and relieving at the same time. It was the first time I felt authentically me. 

It’s 15+ years later, and we’ve helped each other get through many scary thoughts and tough times, come out of the closet to friends and family (sometimes while sitting side-by-side) and navigate difficult romantic relationships as we learned what it was like to be a young gay person in Cleveland, Ohio.

Q: How did you feel as a result of coming out? 

A: After coming out to my best friend, I felt a sense of relief and companionship. Our double lives became more of a shared experience and a lot easier to manage, knowing we had each other to rely on. I also started to feel more comfortable coming out to other friends. At 18, I came out to all my friends. At 22, I came out to my parents and family.

Q: What resources, support groups, or communities did you rely on when coming out? 

A: At the time, I wasn’t aware of any resources or support groups, so this wasn’t something I utilized. Another best friend’s older brother was gay, so I learned a lot from him, and he took me out to introduce me to the community and become comfortable in my own skin.

Q: What advice would you give to others? 

A: The best advice I’d give to LGBTQIA+ youth is to find a support system of like-minded individuals and come out when you feel it’s safe to do so. If you’re in an environment where you feel your mental or physical safety could be jeopardized, don’t come out until those dangers are gone. If being disowned, financially cut-off, or assaulted is a possible reality, make sure you have somewhere safe to go where your basic needs can be met. There will always be people who won’t accept you for who you are, but there will be even more who will support you. You just need to find that community. 

Q:  Why is it important for you to work at a company that values diversity in all forms?

A: Companies that support diversity help us evolve into a more accepting society. When people are exposed to colleagues who are different from them, they get to know each other on a personal level and start to realize that we are all more similar than different. I believe these experiences translate into the way people treat others outside of work and how they raise their children.

At Alto, we believe in a world where every perspective matters and that diversity fosters creativity and creates innovation. We welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for all, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources: 

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

Coming Out with Pride: Nicholas Satow Shares His Story 

Nicholas Satow (center) with Camp Lightbulb leaders

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! Here they share their learnings, accomplishments, and their advice for future Alto interns.

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! In their three months with us they blazed the trail for future Alto interns while adjusting to a new norm of fully remote work during the global pandemic. Here they share their learnings, accomplishments, and advice for future Alto interns.

Coming out of a bootcamp program rather than a traditional Computer Science degree program, Micaela hoped to find a company open to non-traditional educational paths. “I know that a company that is welcoming of bootcamp grads values diversity, inclusivity, and mentorship.” 

For Erik, it came down to his interview experience: “Everyone seemed to really enjoy their experience and really believed in the mission they were working on.” Micaela agreed, adding that it also ultimately came down to the people for her. “You can tell a lot about a company’s culture based on what the people who interview you are like,” she said. “From the recruiter to the engineers, everyone was incredibly friendly and a joy to interact with.”

Blog

Supporting Working Parents at Alto

The Disproportionate Impact of HIV in America

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

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

Airbnb’s Former Head of Business Technology Joins Alto

Coming Out with Pride: Nicholas Satow Shares His Story

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

From Pharmacist to Professor: Sandra Aziz Spotlight

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

Building an Engineering Career at Alto

Alto's Head of Talent Shares His Personal Health Journey

Why a Software Engineer Turned Down 8 Other Offers to Join the Alto Team

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