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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.”

What was the most fun moment of your internship? (That is, assuming you had fun!)

Virtual team lunches were a highlight for all 3 interns. However, one special moment during Micaela’s internship actually came from resolving a ticket that involved writing an end-to-end (E2E) test—something she was not looking forward to. “I was dreading it for two reasons: First, I do not particularly enjoy writing tests—I’d rather write the code that passes them—and second, I had never worked with Cypress before. Several hours later, after reading lots of documentation, studying previously written E2E tests, and getting stumped by a hidden selector, I managed to write the test. When I finally ran it and got to watch the video as it clicked on buttons and filled out inputs, I became instantly enchanted. I may have run it several more times just to watch it, smiling like a goofball, knowing that this test that I had created would be run every time code was pushed and merged.” 

In addition to their respective engineering managers, whom the interns had weekly 1:1s with, each intern was also assigned a dedicated mentor, who committed at least 5 hours a week of dedicated support to their interns over Slack and Zoom. Mentors were able to provide historical and business context, help interns get ramped up on Alto’s tech stack, codebase, and tools, and pair program as needed. “Working with my mentor definitely made me more productive,” said Jordane.

The mentors added that working with the interns actually helped them improve their ability to articulate technical concepts, as well as their ability to talk through technical challenges with others more effectively in their day to day work.

What was it like interning during the pandemic and being fully remote?

“I found myself setting up ‘Hey, there’s a pandemic, and this is crazy, so let’s get introduced virtually, maybe?’ meetings,” said Micaela. “Although, as someone who is horrible with names, it is worth noting that a silver lining to being entirely remote is having everyone’s name in the corner of their zoom video. That, and sweatpants everyday!” 

Erik and Jordane agreed that being remote required a little extra effort. Alto’s engineering office is based in SF, and since they weren’t required to be physically in-office this summer due to the pandemic, both Erik and Jordane were based in other time zones. “In the beginning I was starting my day at 9am EST/6am PST, but if I got stuck I would have to wait until West Coast working hours before I could reach out,” explained Jordane. With time, “I picked up a different working rhythm that worked better for everyone.”

While Jordane was surprised by just “how friendly and accessible everyone was,” Erik was surprised by how quickly he was able to actually deploy code. 

Acknowledging that her chosen career path has a history of gender imbalance, Micaela shared that she “was pleasantly surprised” to have both a female manager and a female mentor. “It was a great experience getting to have two strong female role models to learn from during my internship.”

Micaela and Jordane were both on the Pharmacy Platform team, which defines best practices and processes that promote a future-forward and scalable way of development. The platform team provides tools, libraries, and services that make development work at Alto and enable all of Alto's engineers to write performant code. Erik was on the Pharmacy Supply Chain team, which enables a better, faster experience for patients by ensuring the right medications get out the door, on time, and at the lowest cost possible.

Erik’s mentor, Eric Leite, helped us understand what Erik contributed to the Pharmacy Supply Chain team: “Sometimes our operations workflow requires manual intervention to resolve issues. We use an extendable admin interface to help us navigate the more complex issues. Erik created an add-on to this application that helped our on-call team work more efficiently. We can now resolve a specific kind of complex insurance claim issue by using his add-on to guide us through the multi-day resolution process. Erik learned about our supply chain operations workflow, how insurance claims are processed, how to model out a problem using Ruby on Rails, and how to write effective tests using RSpec.”

Micaela and Jordane, both on the Pharmacy Platform team, worked on optimizing performance and cleaning up legacy code. For instance, Jordane helped standardize Alto’s frontend by increasing adoption of our component library. “Although this was a relatively straight-forward task that didn’t require much problem solving, it did require a lot of endurance,” said Jordane. “I had to edit and test changes to over 300 files by hand. There were many times I could have broken [the platform], and changes needed to be made very carefully.”

What is the biggest learning you are taking away from this experience?

“The biggest learning I am taking away from this experience is nicely summed up by the grail knight in Indiana Jones and the Last Crusade: ‘You have chosen...wisely.’” said Micaela. “I knew I enjoyed software engineering when I was learning it, or when I was working on my personal projects, but that can change when it becomes a job. After spending the summer as a software engineering intern at Alto, I can say with confidence that I have chosen...wisely.”

Jordane discovered that “engineering isn’t just innovation,” as he came into the experience believing; “it’s also investigation.” When we asked the interns’ mentors and managers what they had learned from the interns, they all recognized the genuine curiosity the interns brought into their respective teams and projects, which helped them to see Alto’s codebase through new eyes. They also gushed about the excitement the interns had when pushing to production for the first time.

What words of wisdom would you give to future Alto interns?

All three agreed: ask as many questions as you need to! “Over communicate, and just relax & enjoy the process!” offered Jordane. Erik agreed sharing, “Do not be afraid to reach out when you get stuck. Reaching out for help is essential.” 

“An internship is all about learning and growing,” said Micaela, “so take advantage of the wisdom and experience of your peers. They have a lot to offer!”

Ashley Qian, the Senior Engineer who mentored Micaela, advised, “Know your limits! Take breaks! Find something else to enjoy other than software engineering because your work is not your life, and your life is not work. Surround yourself with people who are your advocates and go to bat for you, and if you find yourself in a system or an environment that does not support you, try to understand what your boundaries are, and leave if you can. You always have a shoulder to lean on if that's the case, here, with the friends you've made at Alto!

Interested in being an intern at Alto? Check out our careers page HERE.

Sandra Aziz, Alto Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award.

From Pharmacist to Professor: Sandra Aziz Spotlight

Sandra Aziz, Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award. This celebrated accolade recognizes Sandra for her contributions to the experiential preceptorship program over the past academic year. In addition to this award, Sandra was recently appointed Assistant Clinical Professor at UCSF!

Preceptors are practicing pharmacists who provide guidance and supervision to pharmacy students. They selflessly act as mentors in addition to their already demanding day-to-day responsibilities. Over the last two years Sandra has mentored ten interns at our Los Angeles pharmacy location. Her responsibilities include building curriculums for their continued learning, and acting as a mentor and coach to help students reach their goals. With Sandra’s guidance, eight students were accepted at their preferred residency/fellowship programs!

Read on to learn more about Sandra, what brought her to Alto and how the Gilmore Girls inspired her.

Congrats on being recognized as an exceptional teacher, role model and mentor! How does it feel? 

It’s really rewarding! I spend a lot of time creating detailed syllabi to provide students with a wide range of learning opportunities at Alto that they likely would not get at another pharmacy. It feels great knowing that students value their experience and learnings with us. Even further, when students are interested in coming back and working at Alto post graduation — that’s the best feeling.

What would you tell pharmacy students considering selecting Alto Pharmacy as a placement site for their rotations? 

If you’re looking to experience how a healthcare technology startup operates, you should absolutely consider Alto!

In this unique learning environment, you will gain a breadth of experience working on projects alongside clinical care staff, engineers, operations managers, and product designers. You will be involved in process improvement projects that improve efficiencies, quality assurance and further preventative healthcare. Ultimately, you will be helping redefine how community pharmacies can serve patients and their communities!

Who is/was an influential person in your life and why? 

I always struggle with this question because growing up, my answer was Lorelai and Rory Gilmore from the TV show Gilmore Girls - two strong, well-spoken women who worked hard to be self-sufficient. 

But the most influential person in my life was my dad; no matter what battle he was facing, he always met it with a smile, kindness, and an awful joke. 

You’ve been with Alto now for three years. What do you enjoy most about being a part of the team? 
My favorite thing about working at Alto is that I get to work with folks from a variety of backgrounds and disciplines on a daily basis: finance, product, engineering, etc. It gives me perspective and allows me to see challenges from various angles and problem solve accordingly. 

And finally, what do you like to do outside of work? 

I love looking at real estate, especially being in LA. My RedFin filter is set to $10M+ and any chance I can get to an open house, I absolutely will. Additionally, I have a sweet little black cat named Noodle whose self-designated play time is 2AM. 

If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

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

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

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

What does a Software Engineer at Alto do?

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

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

Developing a Predictive Interview Process to Reduce Unconscious Bias

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

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

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

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

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

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

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

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

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

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

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

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

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

In this interview, Alto's third engineer shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today at Alto.

Building an Engineering Career at Alto 

This interview has been edited for length and clarity.

Elnaz joined as Alto’s third software engineer in 2016, coming from Lob. She has since gone on to shape Alto’s culture and recruiting efforts and rose to become an Engineering Manager. In this interview, she shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today.

You’ve lived in 8 cities spanning 5 countries and 3 continents! Tell me more about that and how it shaped you?

My family started moving around from a really early age. My dad was a chemical engineering professor in Iran for around 25 years. When my siblings started going to college in the United States, we started moving around to pay for their college tuition. He did a sabbatical in Australia (where I learned English!), a short stint at his alma mater Oklahoma State, time at a research institute in Kuwait, and a few other locations. 

As a result, I’ve been exposed to such extremes in my life in moving from the Middle East to Oklahoma, or between Chicago and San Francisco. I’ve just been exposed to such a variety of people that’s allowed me to both blend in with a lot of different folks, but also be able to be a bridge and a translator. Regardless of whether it's in work or my personal life, I think “passionate” is maybe the most consistent way I would describe myself. I'm either passionate about the work I'm doing or passionate about getting outside for camping and traveling. There's an intensity in all aspects of my life. 

From my past roles, I realized I loved working on cross-functional problems. I stumbled across Alto, eventually realizing that working cross-functionally was such a unique and fundamental opportunity with this company. We would not succeed if engineering sat in one corner and operations in another - we had to work together. The other piece was that I knew I wanted to work on something more meaningful. I felt like I was able to close the loop on what started off my career – working in civic tech and on public interest projects – and do that as a more effective person in the healthcare business. Finally, I wanted to learn more about the business side of things. What I learned in my first job out of school was that nonprofits and civic tech are great, but they don’t work unless you can fund them. I really wanted to find businesses that were viable and also added value.

You were Alto’s third engineer. What was that like?

In retrospect, it was fantastic. I was able to shape the culture, see the evolution of the company, and develop a lot of relationships. For example, I was really passionate about engineering being a partner to the rest of the organization and for us to go into the trenches to understand how the frontlines use our product to figure out how to make things better. I was given a lot of unique opportunities, including working on recruiting to make sure we were building a more equitable interview process, and also ensuring that folks are successful once they got here. I was able to influence Alto’s diversity and inclusion efforts and grow as a leader to pave the path for more people after me.

How was the transition from engineer to management like for you?

The first feeling was just sheer excitement. So much of what I’d been passionate about up until then had been done on the side: building an onboarding program for new hires, building out better interview questions, improving our on-call process. Becoming a manager was validation of how things that I'm good at are not just pure engineering skills, but also things that make engineering more effective. I'd been worried about being perceived as not technical enough, or that the soft skills didn’t matter, and it really validated that what I wanted to work on was valued. The second feeling was, “How do I actually know if I'm doing a good job?” I think that's one of the hardest things when you first become a manager. 

As an engineer, you have these tight feedback loops: you build something, the test runs, and you see the product and the impact. As a manager, you might have a conversation or make one comment to someone only to find out months later what the actual impact of that comment was on the person. I had to get accustomed to slower feedback loops and being more comfortable with less structure.

You were your college’s student government president. Tell me more about that and how it relates to what you do now?

What I quickly learned from that position was that defusing tense situations was my superpower. When there were disagreements between the students and the university, I felt like I could speak to both sides and bridge the gap. That was the first time I really began to appreciate my upbringing of having been exposed to a lot of different cultures and different people. This becomes relevant in basically every intersection at work: how engineering and operations relate to each other, how engineering and design relate to each other, or being able to see different perspectives within the same discipline. 

In particular, I think it was helpful for me to spend time with a design and development firm because I saw the anxiety that designers can have around not solving the problem at the core or being forced to make sacrifices about the fidelity of their solution. Now when I'm working with a designer I make sure they understand when I’m talking about velocity, but I can also put that hat aside and talk about what's possible given a longer timeframe. 

What’s the best piece of advice you’ve ever received?

I've always felt like I've seesawed between coming on too strong or being too shy. The advice I received was to not think about them as binary aspects, but rather celebrate that I have both of those attributes. So when I was weighing the idea of whether I’m really great at people management, does that make me less of a technical person? Or if I'm technical, does that mean I can't be good at the people side of things? I think this advice was really helpful for me to stop seeing it as an either-or choice and recognize I can be great at both. It makes me think of a clip of Dave Chappelle where he talks about advice that his mom gave him that really resonates with me. His mom told him, “Sometimes you gotta be a lion so you can be the lamb you really are.”	

What are you most excited about at Alto in the next year?

Personally, I’m most excited for my parents to be able to use Alto as we expand our service areas so they understand what I've been doing the past three years! Professionally, I'm excited about the big dent we can make in technical scalability, as well as making it easier for our operations team to provide a consistently excellent patient experience.

If you have any questions about Alto, or are interested in joining our team, please reach out via LinkedIn.

Senior Manager, Engineering at Alto Pharmacy

A personal health journey with hyperthyroidism, Graves’ Disease, and Horner's Syndrome led Alto's Head of Talent to improve the patient pharmacy experience.

Alto's Head of Talent Shares His Personal Health Journey

As a patient, I dreaded my pharmacy experience. So I joined Alto to change it. 

My first sign of hyperthyroidism showed up when I was 20 and my struggle with pharmacies started soon after. It would be more than a decade before I found a way to be a part of solving this industry’s problems.

When I first heard about the opportunity at Alto in 2019, I actually laughed. Why would I want to work at a pharmacy? I hated pharmacies. But the recruiter I was working with convinced me to reconsider and after speaking to Jamie, one of the founders, I understood. Alto was unlike any other pharmacy out there. In fact, they weren’t just a pharmacy. They were on a mission to improve patients’ quality of life. I jumped at the chance to fix a broken industry that is hungry for innovation.

I had just come back from a trip to New York and went for a routine run around the neighborhood. I was so drained after running one mile that I had to stop and sit down. This didn’t make sense; at 20, I was in the best shape of my life. As the next few weeks went on, the symptoms worsened: severe chest pain, shortness of breath, and anxiety attacks. Being the stubborn athlete I am, I pushed through it, until one day, I blacked out during a run and woke up lying face down in the dirt. Around that same time, I developed a lazy eye and finally decided to go to the doctor.

After that delayed visit I was diagnosed with hyperthyroidism, Graves’ Disease, and Horner's Syndrome. My standing heart rate was 105, or about 50 BMP more than it should have been! I'm so thankful for my family members and the doctors who acted quickly to get me medical care. While my treatment plan was straight-forward, my experience as a patient on prescription medications became a nightmare. I quickly learned how inconvenient, impersonal, and non-patient-centric the pharmaceutical industry was.

I tried pharmacy after pharmacy, and the issues and frustrations remained the same. My script would be sent to the wrong address, or I’d receive the wrong dosage and brand of medication, even though my medication never changed! It became so routine that once a month, I’d block off two hours to talk through my refill requests with the pharmacy. But like clockwork, the same problems would reoccur—year after year after year. Having told my story to tons of other patients and caretakers, I know I’m not alone in this experience.

Like any disappointed customer in the 2000s, I took to the internet to learn more. What I found was alarming. The NPS scores for the leading pharmacies are abysmal. CVS Pharmacy, one of the largest retail pharmacies, has an NPS score of -10. Yes, negative ten. It's also estimated that up to 50% of medications are not taken as prescribed, creating up to $300 billion in avoidable drug costs annually. Even worse, it's estimated that more than 125,000 preventable deaths each year can be attributed to medication non-adherence. That's three times more than deaths from car accidents nationally!

While there was comfort in knowing others felt my pain and were experiencing the same frustrations, I was angry that there wasn't anything being done about it. I was frustrated, both as a patient and as a civilian, and didn’t know how to try to solve the problem. 

Meanwhile, after graduating college, I began my career in Michigan, where I’m from. Working for a recruiting agency, Aerotek, I was hiring for all sorts of roles—from machine operators to janitors—but I always had an interest in tech.  I found out about Barracuda Networks, a security tech company with an office in Ann Arbor. I originally joined to build their data protection division from 20 to 250. Their office was about 20 people and it needed to grow to 250. I had a ton to learn—when I started, I didn’t even know what a software engineer was! My role evolved quickly, eventually broadening to manage all tech recruiting across the U.S. and later, to building their first international recruiting team.

After almost five years, I started to look at other companies. Quora had been a long-time favorite product of mine. I loved that they connected knowledge with people all over the world. The perspectives I found were genuine, diverse, and fascinating. On Quora, there are professors, industry experts, and people who just got out of prison, sharing their knowledge and experience. I joined Quora to grow their team and jumped into the consumer internet space for the first time. Working there, I learned how to refine and scale processes to enable hiring for balanced and diverse teams. At a certain point though, I was ready for a new challenge, to move outside of an advertising-based business model, and to be in a steep learning curve again.

I had no idea where I wanted to go next. Looking around the Bay Area, I felt that with so many smart, capable people in tech, we could be doing more. I didn’t agree with a lot of what I was seeing, especially in terms of the kinds of problems that were getting the most investment, time, and resources. I’d spent almost 10 years building my career and didn’t even know if I wanted to stay in tech. I’d lost touch with a sense of purpose and meaningful legacy. 

I knew I wanted to have a lot of personal impact, and a mission I completely aligned with. I wanted a company where employees care about the lives they’re touching, the people they’re working with, and the communities they are impacting. And I wanted to work with a small team and grow it. I didn’t know if I could find all of that within Silicon Valley.

Then I got introduced to Alto. I toured the pharmacy, met with the leadership team, and learned about their ambitious plans for growth, and how I could be part of making those happen successfully. The things I noticed during my interview process with Alto are still very real today as an employee, especially the level of empathy people bring to work. Alto was the first place I interviewed where people were truly getting to know me, and understanding the motivation behind my past professional decisions.

I joined Alto in August of 2019 as their Head of Talent. I'm grateful to have the opportunity to work for a company whose culture, people, and mission are centered on supporting others and making a change in an industry that hasn't seen any significant transformation in the last 50 years. We’re seeking to understand but also wanting to be principled in our approach, and not compromise on patient health outcomes. 

Over the last year, the recruiting team has grown from 4 to 30, and our primary focus has been embedding solutions focused on building a diverse workforce. From implementing our first early talent apprenticeships, to building an inclusive hiring process by creating a training culture, we've grown the company from 180 to 750 across 4 states and 7 office locations.

This industry serves a diverse population and I’m learning a ton along the way. Working at Alto allows me to be a part of creating a healthcare solution that will truly be patient-centric. I want to continue to surround myself with people who have the same passion and bring their unique experiences, thoughts, and ideas to help us build tomorrow's pharmacy and fulfill medicine's true purpose: to improve quality of life—for everyone who needs it.

Alto’s Head of Talent Shares His Personal Health Journey

Utsav Ahuja, software engineer at Alto, shares why he joined the team after a thorough job search that included offers from companies including Google, Dropbox, Amazon, and more.

A software engineer's journey to Alto

After a thorough job search, I recently started working at Alto Pharmacy. In this post, I share why Alto is a special opportunity that I feel privileged to be a part of.‌

Alto is, at its core, a pharmacy. A pharmacy is traditionally defined as: "a store where medicines are prepared and sold." Indeed, Alto satisfies that definition, but it goes further than that. The most obvious way is through same day, courier delivery, but that's just one piece. For example, Alto also handles the complex coordination required between a patient, their healthcare provider, and their insurance.

There were many facets that attracted me to the opportunity in the retail pharmacy industry:

Market size: In 2018, drug spend in the U.S. topped $420 billion, and its only increasing. In 2015, just 3 years prior, it was $364 billion.[1]

Ripe for disruption: Of the top 25 retail pharmacies in the U.S., not a single one was founded after 1976.[2] The 5 largest pharmacies in the U.S. are, on average, 86 years old.

The status quo: The NPS for one of the largest retail pharmacies in the U.S., CVS Pharmacy, is an astoundingly low -5.[3] That's right, negative. For comparison, that's worse than Comcast (-3). Worse still, a recent New York Times article highlighted severe issues at chain pharmacies, caused by chronic understaffing and corporate profit-seeking. One pharmacist reported to a regulator, "I am a danger to the public working for CVS." [4]

Lives at stake: It's estimated that up to 50% of medications are not adhered to, creating up to $300 billion in avoidable drug costs annually.[5] Even worse, it's estimated that more than 125,000 avoidable deaths each year can be attributed to medication non-adherence, more than 3x than from car accidents.[6] Alto's patients' adherence rate is 77%, 30% higher than the industry average.

Delivery: By delivering medication, one Alto Pharmacy can service the equivalent of 400 chain pharmacies. This leads to substantial savings in retail expenses and better utilization of pharmacists and technicians.[7]

Centralized, specialized care: By centralizing pharmacists and the care team, each member can be more specialized in particular therapeutic areas--such as fertility or psychiatry--than the traditional retail pharmacist.

Customer happiness: Alto's NPS is astonishingly high, not just for a pharmacy, but for any customer facing business: over 80.[8] Indeed, Alto's reviews on Yelp are overwhelmingly positive.

Provider Experience: AltoMD, Alto's platform for healthcare providers, saves doctors and other providers on the platform tens of hours of paperwork, coordination, and other administrative tasks each week. The platform also gives visibility into the fill status of patients' medications, something that most providers do not have today.

Extra Mile: Alto coordinates proactively with healthcare providers and insurance to resolve issues, such as submitting prior authorizations and handling billing issues.

Patient first: Alto always puts the patient first. For example, Alto is always looking for the best price for the patient, whether it be through the patient's insurance, using a coupon, or rebates. Even if it reduces--or eliminates--Alto's profit. These cost savings aren't small; by last count, Alto has saved its patients $23 million.

Alignment on mission: Alto is a mission-driven company, and while many companies have missions on the wall, it's rare to see strong alignment on a mission. In every encounter with I had with Altoids, their earnest belief in the company and passion for the work it was doing was unmistakable.

Leadership: Alto's CEO, Matt, and CTO, Jamie, are modest, determined, and passionate. Their humble approach to building a company is a rare breed. For example, consider how Alto started: by buying AG Pharmacy, an independent pharmacy in the Mission District of San Francisco. The reasoning was simple--they needed to truly learn the needs and services a pharmacy fulfilled before they could hope to improve it. Just listen to Matt talk about Alto on recent podcast, and I think you'll understand why I admire, and believe, in them.

Engineering growth. Alto plans on quadrupling its engineering count in 2020. It was exciting for me to be a part of that because I knew that would be a critical period in the company. Furthermore, they had accomplished so much already with fewer than 25 engineers. This was impressive because Alto has to work with 4 distinct parties--insurance companies, healthcare providers, its own operations team, and consumers--and build software that brings them all together.

Ambitious expansion plans: Alto aims to serve 100 million people by 2025. This expansion will allow Alto to redefine the role a pharmacy plays in people's lives.

I'm inspired by Alto's commitment to always put patients first. I'm inspired by the ambition to fix a massive, fundamentally broken industry, piece by piece. But most of all, I'm inspired by the notion that a company can both be a good business and a force for good. We need more of those in our world.

If this inspires you too, I invite you to apply and join us. Even if you're skeptical, I still invite you to apply. I think you'll find an ambitious group of people in service of one mission: to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it.

If you have any questions about Alto, or ideas to make it better, please do let me know. I'd love to talk to you.

1. https://drugchannelsinstitute.com/files/2019-PharmacyPBM-DCI-Overview.pdf 

2. Not including mergers and acquisitions. https://www.skainfo.com/reports/most-powerful-pharmacies 

3. https://customer.guru/net-promoter-score/cvs-health 

4. https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html 

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/ 

6. https://www.pillsy.com/articles/medication-adherence-stats 

7. https://blog.alto.com/how-alto-pharmacy-is-using-tech-to-put-patients-first-3be4d1c61013 

8. https://blog.alto.com/https-blog-alto-com-reinventing-the-community-pharmacy-be9d80d48722f 

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

Utsav Ahuja shares why he joined Alto despite offers from companies including Google, Dropbox, Amazon, and more.

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

Alto’s expansion brings free daily doorstep delivery of medications to Denver-Boulder metro area residents

Starting Wednesday, April 15, residents of the Denver-Boulder metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Monday - Friday: 6:30 – 9:30 pm MT in Denver, 7 - 10 pm MT for Boulder and outlying areas
Saturday: 2 – 5 pm MT in Denver, 2:30 - 5:30 pm MT for Boulder and outlying areas

Monday - Friday: 12 – 6 pm MT
Saturday: 9:30 am – 6 pm MT (closed on Sundays)
Please note that we are currently offering curbside pick-up only for walk-in business.

Denver and Boulder area residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch.

Alto is proud to call Denver our second home. Our HQ2, located in Denver’s Golden Triangle neighborhood, employs more than 225 area residents in pharmacy, operations, finance, engineering, and customer support. We’re committed to bringing exceptional care to our families, neighbors, friends and fellow healthcare professionals. 

“As a member of the Denver community, I’m excited to bring the Alto pharmacy experience to my neighbors and family,” says Andrew Storjohann, Pharmacist in Charge of Alto’s Denver location. “As a pharmacist and healthcare professional, I’m particularly glad more residents will now have access to our contact-free delivery model - it’s the safest choice for medication needs during our current shelter-in-place period for COVID-19.”

Once things get back to normal and we’re all moving out and about, come say hello! Stop by during our in-person pickup hours to meet Andrew and the team. We're located at 929 Broadway in downtown Denver.

General customer support hours are Monday - Friday 10 am - 10 pm MT and Saturday - Sunday 11 am - 7 pm MT. Patients can reach out to Alto via phone/text at 1 (800) 874-5881, email or app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and currently delivers across the greater Bay Area, Los Angeles, Orange County, Seattle, Denver and Las Vegas.

Mattieu Gamache-Asselin, CEO & Co-founder

On August 1st, 2015, I was so excited to move into my shiny, new office: a storage closet. I looked across to my co-founder, Jamie, and wondered how two engineers from Facebook ended up in the back of a small, family-run pharmacy in the Mission.

Earlier that summer, Jamie and I had left our jobs to start a company that could create lasting change in the world and have massive impact on people’s lives. We were drawn to healthcare and shocked to learn that in the U.S., 50% of people don’t get or take their medications as prescribed. This problem, referred to as medication non-adherence, is one of the country’s leading causes of hospitalization and deaths, and is often due to the high costs and friction in the pharmacy experience. We’d both been at big, retail pharmacies and saw how broken the system was — deeply inefficient and in many ways, inhumane. So, we decided to start by tackling pharmacy.

We ran some Facebook ads, offering a pretty simple service that would pick up your prescriptions and deliver them to your doorstep. That first week, we succeeded in delivering medications to our first happy, paying customers. We thought speed was the key benefit, so we named the company “ScriptDash.” Little did we know, we would need to build so much more (including a new company name, Alto — a nod to a higher, elevated experience).

We heard about a small, beloved community pharmacy, called AG. Located at Army & Guerrero in the Mission district, AG had been owned by pharmacist Vivian Cheung for over 30 years. We befriended Vivian, and she let us follow her around and learn. As weeks went by, we became more curious and amazed by all the backend steps required to make things work — not only behind the counter at the pharmacy, but also between the doctor, the insurance companies and the patient. Vivian was very kind and patiently explained every step to her two newest ‘interns.’

One day, we were watching Vivian prepare a prescription for a patient, Walter, when she noticed that the copay increased from last month’s copay by a few dollars. Vivian knew that for Walter, a few dollars would matter to him. We watched Vivian pick up the phone to call Walter and explain the copay change. Walter was thankful for Vivian’s call and ultimately came in to pick up his meds that evening. It was that day when I realized that what patients need is for their pharmacist to really know them — the way Vivian knew Walter’s health conditions, medication history and his preferences — so that pharmacists can help patients navigate the complexities of healthcare and get the medication they need. I was excited to think about how technology, alongside a caring, patient-focused pharmacy team, could help us bring this type of experience to millions of patients who desperately need an expert pharmacist like Vivian in their corner. It quickly became clear to us that what patients needed was way more than just delivery, that in order to do this right, we needed to be a fully-fledged pharmacy.

Looking back, one of the most important moments in Alto’s history was raising enough capital to purchase AG pharmacy, allowing us to continue partnering with Vivian and her team. We were fully aligned on our mission, and couldn’t have imagined doing this with anyone else.

Being fully immersed in the pharmacy and working alongside pharmacists every day allowed us to more deeply understand the issues with the existing pharmacy experience and why so many patients don’t get or take their medications as needed. We quickly built out our team, bringing together even more expertise across both technology and healthcare, grounded by the core values and caring ways we learned from AG. That first year, we also built the core pieces of our technology stack — our pharmacy operating system, our physician collaboration tool and an app for Alto patients.

Fast-forward to today. We’ve far outgrown that storage closet. We now serve tens of thousands of patients across multiple cities and multiple specialties, all made possible by our incredible team of nearly 300 and the technology platform we’ve built. We’re able to better educate patients about their medication and pricing, deliver medication to their doorstep and provide expert pharmacist advice on an ongoing basis. We are thrilled when customers tell us that they are happy (our NPS satisfaction rate is 80+, compared to pharmacy chains with 5 points) and healthier (we’ve seen our patient’s medication adherence rise to 70% from the industry norm of 50%). That first year with AG really shaped our vision for what a great pharmacy could be and the type of multidisciplinary team we’d need to build it. It’s amazing to think about how far we’ve come, but in many ways, it still feels like the early days. There’s so much more we need to do to bring this type of caring, community pharmacy experience to all the patients who need and deserve it. We are still just getting started!

Working at Alto isn’t just a job. For every team member, from product designers to pharmacists to patient care gurus, Alto is a means to a fulfilling career focused on making a difference in the lives of people who rely on prescription medicine to lead healthy, happy lives. In the process, we’re also changing an industry that has long gone unchecked.

Our mission is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. That takes a dedicated team of mission-driven, value-minded people. Read on to figure out if Alto is the right career move for you.

At the highest level, Alto is a pharmacy. But we are not a traditional pharmacy. Instead of operating dozens of small-volume distribution sites across a metro area like chain pharmacies, we own and operate high-volume pharmacy fulfillment centers staffed by small, highly efficient teams supported by proprietary technology. We have one fulfillment center per metro area that we serve, including San Francisco, Los Angeles, and Orange County, and a centralized operations facility in Denver. Out of our fulfillment centers, we process and fill prescription orders and deliver directly to patients’ homes or offices by way of our free, same-day courier service.

On top of the convenience and accessibility of same-day delivery, Alto has three product pillars that allow us to deliver an exceptional experience to our users: the Alto Patient app, Alto MD, and Wunderbar. Learn more about our products and our industry-disrupting business model.

Alto is the world’s most patient-centric pharmacy. Our goal is not simply to distribute prescription medications but to improve patients’ health outcomes and their quality of life and to make those improvements accessible to everybody.

To get to that point, we need to understand what’s preventing patients from accessing all the benefits medicine has to offer. We believe it’s especially important to address the high-level problem of non-adherence, which is when patients don’t take the medication they’re prescribed. It also means learning how to scale our technology and processes to bring our products to more people in current and new markets. To achieve both of these things, we need to first scale our team. Learn more about Alto’s potential for growth and plans for the future, and how our team contributes to our success.

Loving what you do starts with doing something you believe in. It’s enriched by working alongside people who share your goals in an environment conducive to your work style and aspirations. At the foundation of Alto’s culture is our mission; our core values like acting empathically, thinking rigorously, making impact, staying humble, and putting patients first; the diverse backgrounds of our team members; and the supportive but highly autonomous way we get work done. Learn more about the Alto’s values and culture through the eyes of our CTO and co-founder, Jamie Karraker.

If Alto sounds like an environment you would thrive in, we would love to hear from you! We’re always on the lookout for great people to fill in our product, design, engineering, analytics, people, recruiting, finance, sales, business operations, logistics, pharmacy, and patient care teams. Check out our open positions to see if there is an opportunity that’s right for you!

Why Mission-Driven Software Engineers Hold the Key to Alto’s Continued Success

Alto is the world’s most people-centric pharmacy. Our goal is not simply to distribute medications but to improve health outcomes and quality of life. What’s more, we want to make those improvements accessible to everybody.

To get to that point, we need to understand what is preventing people from accessing all the benefits medicine has to offer. We believe it’s especially important to address non-adherence, which is when people don’t take medications as prescribed. Non-adherence is a national problem that causes 125,000 avoidable deaths per year (more than three times the number of car accident deaths) and $300 billion in avoidable medical costs (more than half the money spent on pharmacy as a whole).

It also means learning how to scale our technology and processes to bring our products to a bigger swath of the population. To achieve both of these things, we need to first scale our engineering team.

Because of our unique business model, Alto is positioned to pursue three exciting growth vectors:

New Therapeutic Specialties: In addition to our general pharmacy capabilities, we have developed specialized expertise and infrastructure for managing complex treatments like fertility, dermatology, HIV, psychiatry, and other therapies that come with sticky coordination issues and unique considerations. We have made it easier than ever for people to navigate these treatment areas, but there is more we can do. Our team has identified 26 additional treatment areas that could benefit from specialized technology and processes. Mastering those areas is high on our to-do list.

New Geographic Markets: By expanding into the top 50 U.S. cities, we could potentially serve 55% of the country’s population. If we expand to the top 100 cities, our coverage would increase to 70%.

New Clinical Partnerships: Alto facilitates coordination between our team, healthcare providers, insurance companies, and the people taking the medications. In the process, we improve workflows and health outcomes. That offers a powerful benefit to clinics, medical groups, and hospital systems. Because of that reputation, we currently have a waiting list of healthcare providers who want to partner with us. That’s more demand than we can keep up with, which isn’t such a terrible problem.

When Opportunity and Demand Exceed Capacity

Alto is in a fortunate position. It is rare among companies to have multiple compounding growth vectors and a reserve of would-be partners angling for our product. We are not demand constrained, we are operationally constrained, and even then, we continue to double our business every six to nine months — just not as quickly as our potential promises.

Scaling up as a means of reaching our potential is an exciting challenge we’re already tackling. In late 2018, we closed our Series C, giving us the fuel we need to build out our engineering team and develop the technology and processes that will make our continued growth possible. That work will entail fleshing out each of our existing product areas, scaling them, and identifying and solving even more deep-rooted industry issues through better technology and better processes.

Currently, Alto boasts a small but talented and agile engineering team staffed by individuals who honed their experience at some of the biggest names in tech like Facebook, Google, Uber, 23andMe, MIT, Stanford, and Berkeley. All of our engineers are relatively senior, so everyone has autonomy and ownership over their projects. It’s a collaborative, supportive, mission-driven environment, which is how we’ve been able to build so much in a relatively short period of time.

Up until now, we have been deliberate about keeping the team small, but we’ve reached an inflection point. In the next 18 months, we’re looking to increase the engineering team four-fold. With our new team in place, we will be in a great position to focus on our objectives: building and perfecting our operational efficiencies and product scalability.

We’re approaching the challenge of scalability from a few angles:

One is automation. We want to take the algorithms that are in our employees’ heads and put them into code, so they can focus more on caring for patients rather than logistics. We’ve done a bunch of automation work already, but there’s a lot left to do.

We’re also intent on designing tools to help our own team be more efficient with their time, which will mean better UX, better UI, more batching, and less context switching.

The third angle is self-service, and it’s the one we’re focused most intently on. Right now, there is significant human interaction between our team and consumers because we want to make sure consumers have the information they need to make optimal healthcare decisions. In our next phase of growth, we want to automate that process without losing any transparency or depriving a consumer of any agency, no matter their technological competence.

Essentially, we want to build the pharmacy version of TurboTax (without the part about lobbying to keep the system broken). With the right prompts and information, TurboTax walks users through the U.S. tax system, which is huge and complicated. In effect, the user becomes totally self-servicing. We want to do the same for the people who use Alto. That said, not everybody is proficient or comfortable with technology. In the spirit of accessibility and inclusivity, it will still be important that everyone who uses Alto also has the option to speak to a real, knowledgeable, and friendly person to get their questions answered and needs met. We have a responsibility as a healthcare provider to take care of all our patients, no matter how tech-savvy they might be, but for these patients we can still use technology to enable our team to get the patient the best possible option, quickly and easily.

Our engineering team is working toward products with even more expertise built in. In the process, we will also make our operations more efficient and more scalable, unblocking barriers to expansion in existing markets, new markets, and new verticals.

When we succeed at that alignment, we stand to change the nature of the industry. To get there, we will continue to grow our engineering team with right-fit, world-class talent that not only has the skillset to take Alto to the next level but also the values to keep us aligned and mission-driven in the process.

Learn more about Alto’s company values and mission-driven work culture.

To Alto’s CTO, an ethical, altruistic, supportive workplace is everything.

Every morning (ok, most mornings), I wake up motivated — eager, even — to get out of bed and go to work. But it’s not because I am some super-performing success-bot. This is not another blog post about a c-level executive’s otherworldly, highly-meticulous-yet-seemingly-effortless morning routine, and I have no prescriptive regimen for staying happy and mindful while still managing to “get it all done.” I only have one piece of advice, but it is one that has served me (and my mornings) well:

Work with people who share your passion and values.

At Alto, the company I co-founded in 2015, everyone, from me (the CTO) to product engineers to part-time prescription couriers, is dedicated to the same mission and vision. Every day, we strive to improve health outcomes by optimizing technology and processes to become the world’s most people-centric pharmacy. I am never not excited to work alongside the few hundred Alto employees that daily act in concert to support the success of our company and make a difference in the lives of people who use Alto.

Underlying this relentless drive toward mission and vision is a set of shared core values that defines our internal culture:

Blog

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The Founding Story of Alto

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How Alto Pharmacy Is Using Tech to Put Patients First

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