Expires 04/01/2021

Specialty Pharmacy

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Alto Pharmacy Technician

Alto Pharmacist

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

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

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

Alto / Blog

In recognition of Women’s History Month, we highlight four women at Alto shaping the future of pharmacy. These leaders share their advice for women in the workplace, their unique super powers, and what they appreciate most about Alto's culture.

Celebrating Women at Alto Pharmacy

Liz Kelly, National Sales Manager Fertility 

I'm responsible for hiring, coaching and supporting the needs of the national fertility sales team. I also work closely with fertility business and operations teams to deliver on our clinic and customer promises.

Before joining Alto, I was finishing up a sabbatical where I spent my time volunteering on the board of a non-profit called ServeHAITI. Prior to that, I was the West Coast Area Business Director at EMD Serono and worked with Matt and Jaime [Alto’s co-founders] to secure a contract to distribute fertility meds when they were still working out of AG Pharmacy!

What do you appreciate the most about Alto's culture? 

Hands down my favorite part of being on the Alto team is that the patient is truly at the center of every decision we make. I value that we make business decisions with our mission in mind.

What do you like doing outside of work?  

Of late, my favorite pastime is heading to the dog beach with my rescue, Bodhi, who has been the best medicine to ease some of the COVID-19 isolation I experienced over the past year. Before the pandemic, I made sure to travel to at least one new international spot a year. I love the experience of getting exposed to all things about another culture: cuisine, culture, belief systems, language.

I like to think that my super power is seeing the greatness in others, sometimes before they see it in themselves.

I aspire to live by the motto "be the change you wish to see in the world." I encourage women to speak up for what they believe is right, even if nobody else agrees. That includes planning for your own career path and making it a priority to develop your skill sets so that you are prepared to climb the ladder that serves your own greatness.

I graduated from pharmacy school in May of 1979 and started working at AG Pharmacy after passing my boards later that year. I bought AG in 1998 when the previous owner wanted to retire - he had been with AG since it first opened in the early 60's.

My family moved to San Francisco from Hong Kong when I was five years old. Our story is one similar to those of many immigrant families who came to America looking for a better life in search of the American dream: own a home, have a car, raise children safely and give them the opportunity of a good education and a chance to have a better life. My parents raised their children here, emphasizing family, hard work and education. They lived their American dream, and I have them to thank for all that I am today.

What’s your favorite thing to do outside of work? 

I love to travel. There are so many unique places to visit in this world. With the different cultures, the food, and the amazing sceneries/landscapes, there are endless things to see and experience! 

The thing I appreciate most about Alto's culture is that everyone works so hard together to bring about the best pharmacy experience for all our customers. You can feel the energy and the motivation of all the Altoids. I cannot emphasize how amazing it is to be a part of this team and to watch Alto grow and evolve into the pharmacy of the future and the pharmacy of our dreams!

What’s your favorite memory thus far at Alto? 

In the very early days, when Alto was still Scriptdash Pharmacy, a customer needed to get her trigger shot [as part of a fertility protocol] within the next few hours. It was close to rush hour, and we had no couriers available to deliver to the South Bay. Our CEO Matt came to the rescue on his motorcycle, and off he went to make the delivery. It was such a wonderful and warm feeling to watch and cheer him on together. That is truly what Alto love is all about!

I manage our amazing IT Support team, helping all Altoids get the technology support they need, when they need it. 

For the better part of the last decade I have been managing IT Support teams. From Facebook and Twitter to Lyft and Uber, I’ve seen it all (or at least most of it!).

Our incredible dedication to our mission. In my short time here, I truly see us putting patients first, and it’s moving to see. 

What do you like doing outside of work? 

I’m a big traveler, but since COVID-19 has put a damper on that, I enjoy flying around Colorado with my partner in our vintage Beechcraft Bonanza. I also love hopping on my motorcycle and just exploring! 

I’m in love with Central and Eastern Europe. Some of my favorite places are Prague, Vienna and Budapest. 

Elnaz Moshfeghian, Senior Engineering Manager

I’m originally from Iran but moved a lot growing up, including Oklahoma, Australia, Qatar, Kuwait, and Chicago. I have been in San Francisco for the last six years. I stumbled across software engineering in college and found a passion for building products and teams. I joined Alto as the third engineer and this is now the largest company I’ve ever worked at. 

I lead a group of 20 engineers across three teams. Two teams are focused on getting prescriptions ready to schedule quickly and accurately, and one is focused on enabling faster, higher quality, and more enjoyable product development across the broader product and technology organization. My work involves a lot of collaboration, creativity, transparency, and flexibility. 

I was an early software engineer at a small startup; before that I was a hybrid software engineer and product manager at a design and development studio. 

I like how passionate everyone is about what they do. 

I’m at my best managing a crisis or finding a path through conflicting strong opinions. 

I want to start with some advice for our allies: get more curious about the experience of the women you work with and learn about ways you can support and amplify the work of the women around you. Diversity, equality and inclusion is a team sport and, even if we win a game or two, it’s about the continuous pursuit of excellence. 

For my fellow women at Alto, I wish I knew earlier to focus more on improving my craft and impact so I can get a seat at the table, rather than trying to juggle advocacy and my own work. Once you’re at the table, you can really advocate for hiring, growing, and retaining women. 

To learn more about the work of our six employee resource groups (ERG’s) focused on building community - including Umoja (Black), Auténtico (LatinX/Hispanic), Women (WOAA), Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents - read our 2020 Diversity, Equality and Inclusion Report. 

Are you passionate about shaping the future of pharmacy? Join us as we deliver our industry-leading pharmacy care to millions of Americans. 

If you have received a prescription delivery from Alto, chances are high that you’ve noticed a caramel sitting alongside your medications. Read on to learn more about Béquet Confection’s start and how this female-founded business remains successful twenty years later.

Béquet Confections: The Story Behind Alto Pharmacy’s Caramel

If you have received a prescription delivery from Alto, chances are high that you’ve noticed a caramel sitting alongside your medications. Alto’s co-founders knew early on that they wanted to include an unexpected moment of delight in each delivery: “We wanted to put a smile on our customers' faces, knowing that taking medicine may not always be the most pleasant experience,” shared Matt Gamache-Asselin, Alto’s CEO and co-founder. “After tasting Béquet’s caramel, we knew we found a winner.”

Read on to learn more about Béquet Confection’s start and how this female-founded business remains successful twenty years later. 

Béquet Confections was founded in 2001 by Robin Béquet and is now one of the largest gourmet caramel manufacturers in the U.S. Robin transformed her hobby into a full-fledged entrepreneurial endeavor at the encouragement of friends and family who couldn’t get enough of her gourmet caramel.

Twenty years later, Béquet Confections continues to delight customers across the nation with varieties such as Celtic Sea Salt®, Salt-Chocolate, and Butterscotch. They’ve received numerous accolades including the sofi™ award, presented by the Specialty Food Association, which is considered one of the most prestigious awards in the gourmet food industry. 

So what sets Béquet Gourmet Caramel apart from the competition? It’s about having a passion for doing something better than anyone else, and that starts with using high quality ingredients. 

The entire process takes place at a facility in Bozeman, Montana, the town where Robin originally started the business. Each batch of Bequet’s Celtic Sea Salt® caramel is hand-crafted under the watchful eye of a master caramel chef, and includes non-GMO sugar, antibiotic-free milk and, of course, authentic Celtic Sea Salt®. This particular grey salt is harvested from the north of France and undergoes a thorough sifting process. 

The raw ingredients are poured into small stainless steel kettles and slow-simmered to a very specific temperature. This a key component of the process as temperature dictates both the flavor and color profile of the finished sweets. Once the caramel is cooked to perfection, it is poured onto a cooling table and cut into strips. The staff then completes a quality control check to ensure the salt is evenly distributed  for the perfect balance of sweet and salty. 

Robin credits the community of Bozeman for supporting her dream and helping the business grow. Without the local assistance of retailers who took a chance on stocking the product, neighbors who championed for her, and even landlords who offered reduced rent, Béquet Confections wouldn’t be where it is today. 

Two years ago, Life is Sweet purchased Béquet Confections. “We’re proud to be a part of the Life is Sweet family of brands and look forward to continuing Robin’s legacy of producing the most exquisite gourmet caramel,” shared Lyndsey Althans, Director of Finance & Administration at Béquet Confections.

To learn more about Béquet Confections and find a local retailer near you, visit their site. Use the code ALTO20* to save 20% off your next online purchase. 

*Limit one use per customer, shipping fees are excluded. Not valid in stores or on previous orders; may not be combined with other offers. Béquet Confections reserves the right to terminate special offers without notice at any time.

Whether you’re wondering if your child has asthma or they’ve already been diagnosed, here are the common symptoms to look out for, the treatment you can expect.

How to Manage Your Child’s Asthma

Of the over 19 million people who have asthma in the United States, nearly 6 million of them are children. This chronic disease makes it hard to breathe and thus can affect every aspect of your child’s life, from school to play. And with allergy season just around the corner, you might hear extra coughing and sneezing around the house. Whether you’re wondering if your child has asthma or they’ve already been diagnosed, here are the common symptoms to look out for, the treatment you can expect, and the impact COVID-19 could have on those with asthma.

What are the signs my child might have asthma?

The signs and symptoms of asthma can vary by child but, in general, some common signs your child might have the disease include coughing, shortness of breath, wheezing, and tightness in the chest. The severity of these will also vary, with some cases being mild and manageable and more severe cases requiring emergency care.

Symptoms appear when your child is exposed to triggers like pollen or smoke. Triggers cause the airways to become inflamed, which causes swelling and mucus production, and leads to an overall narrowing of the air passageway making it harder to breathe and leading to the above symptoms. 

Since symptoms of asthma can be signs of other ailments as well, it can be difficult to always know if what your child is experiencing is asthma. Coughing, for example, can also be a symptom of a cold or the flu. Another asthmatic symptom—wheezing—could also be caused by bronchitis or another respiratory problem. 

This is where other asthmatic signs like your child saying “I’m always coughing” or “My chest feels funny,” can be helpful. Either way, if your child shows any of these symptoms, it can be a good idea to make an appointment with your doctor so your child can start getting treatment if needed.

Your doctor will likely use a few different methods to test if your child has asthma. First, they’ll ask for your child’s medical history, where they can share symptoms and any triggers they may have noticed. Then the doctor will conduct a physical exam which will look at your child’s nose and throat, their breathing, and skin for any signs of allergic conditions. They may also conduct a series of lung function tests and a chest or sinus X-ray.

The doctor will then look at the results of these tests to discern if your child has asthma and what type. From there, they will develop a treatment plan based on the type and severity of your child’s symptoms.

A quick-relief inhaler may be enough to keep symptoms under control for mild cases of asthma. Depending on how your child is doing, more treatments can be added if needed. Maintenance treatments can help reduce the need for quick-relief inhalers. In fact, how often these inhalers are used is an indicator of asthma control for doctors and can help them determine the proper treatment plan. 

The second main aspect of treatment is avoiding triggers. The most common triggers include irritants such as air pollution, cold air, odors or smoke, as well as mold, dust mites, and pollen. Other triggers include sinus infections, exercise, heartburn, and allergic reactions.

Since the world is unpredictable, you can’t always control triggers, but you can take certain measures to help keep them in check, such as changing your diet when food reactions occur, minimizing smoking, and requesting an indoor air assessment. A variety of virtual asthma education classes and workshops are also offered online to help you learn best practices when it comes to prevention and treatment. 

What effect does COVID-19 have on my child’s asthma?

According to the CDC, those with moderate to severe asthma may be at an increased risk for more severe illness from the virus that causes COVID-19. To help reduce your risk, it’s recommended that you continue taking your current medicines, including any inhalers with corticosteroids in them. The CDC also recommends that you keep a 30-day supply of your asthma medications on hand so you don’t risk running out if you fall sick, need to quarantine, or otherwise can’t make it to the pharmacy.

In addition to these asthma-specific strategies, the everyday COVID-19 protocols of wearing a mask, socially distancing, and avoiding large crowds should be followed. If you’re worried that wearing a mask might affect asthma symptoms, research that came out last month showed that wearing a mask did not affect oxygen levels, regardless of whether the wearer had asthma or not. 

If you have concerns about your condition or think you may have been exposed to COVID-19, you should call your healthcare provider. If you don’t have a provider, you can contact your nearest community health center or health department. 

Many people live normal lives with proper asthma management. A good treatment plan, guidance from your doctor, and a reliable pharmacy can help you manage your child’s symptoms so they can keep doing most of those everyday activities they enjoy. 

We’re here to help your child breathe easier

Whether you need to get your child’s first inhaler or obtain prescription refills, Alto is here every step of the way. Our pharmacists are on hand to answer any questions and our pharmacies around the country are fully stocked with asthma medications. We’re prepared and ready to deliver your medicines throughout the COVID-19 pandemic. To ensure safety, we offer free, contactless drop-offs for every prescription, so you can get your refills on time in the comfort of your home. Reach out any time via text, phone call (1-800-874-5881), or in-app messaging.

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

Despite its reputation, cholesterol is not inherently bad. Our pharmacists explain what is meant by good and bad cholesterol and how to maintain healthy cholesterol levels.

Cholesterol 101: The Good vs. The Bad (And What to Do About It)

Despite its reputation, cholesterol is not inherently bad. In fact, some cholesterol is not only good but necessary for our health. Your body needs cholesterol to build cells, help with digestion, and produce hormones. The problem comes when you have too much of the bad type of cholesterol. This can put you at risk for coronary heart disease, a heart attack, or a stroke. Here’s what you need to know to help keep your cholesterol levels in check and healthy. 

Cholesterol is a soft, waxy, fat-like substance that’s found in your bloodstream and in your cells. Since it doesn’t dissolve in the blood, proteins—called lipoproteins—carry cholesterol to where it is needed in the body. Lipoproteins are made up of cholesterol and triglycerides, which are a type of fat the body uses as an energy source, just like carbohydrates. 

Cholesterol comes from two sources: your liver and certain foods you eat, like meat, poultry, and dairy. Your liver, however, makes all the cholesterol your body needs for your cells, digestion, and hormones.

What is meant by good and bad cholesterol?

There are two types of cholesterol: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is also called “bad cholesterol” because it can build up on the walls of your blood vessels, increasing your risk of a heart attack or stroke. HDL, on the other hand, is considered “good cholesterol” because it can help clear these buildups by removing the bad cholesterol from your body.

Higher levels of HDL cholesterol are associated with a lower risk of atherosclerosis, heart disease, and stroke. So, in general, you want to have higher HDL levels and lower LDL levels to keep your heart healthy. A blood test can measure the amount of each type of cholesterol in your blood. In general, the Cleveland Clinic recommends that you keep your total cholesterol under 200 mg/dL, your LDL cholesterol under 100 mg/dL and your HDL cholesterol over 50 mg/DL for women and under 40 mg/dL for men.

How can I maintain healthy cholesterol levels?

Keeping your cholesterol levels in check and maintaining good heart health primarily comes down to your diet and lifestyle. Here are the American Heart Association’s (AHA) recommendations for what to load up on and what to avoid. 

Whole-grain foods (bread, pasta, brown rice)

Lean meats and poultry without skin. If you choose red meat and pork, select “loin” and “round” options to help minimize the amount of fat. 

Fish like salmon, trout, tuna, and sardines

Unsalted nuts, seeds, and legumes (dried beans or peas)

Non-tropical vegetable oils like olive, corn, canola, or safflower oils

Full-fat dairy products (whole milk, cream, ice cream, butter, and cheese)

Baked goods made with saturated and trans fats like donuts, cakes, and cookies

Foods with “hydrogenated oils” in the ingredients

Tropical oils like coconut, palm, and palm kernel oils

Solid fats like shortening, stick margarine, and lard

What other lifestyle choices can help improve my heart health?

Fortunately, the go-to practices for keeping your heart healthy are a lot of the same ones that are recommended for keeping the rest of your body (and brain) tuned up. Here are four lifestyle choices to consider to support your heart health.

Studies show lacing up those sneakers is key to a healthy heart. Frequent exercise has been associated with a decreased risk of developing cardiovascular disease as well as low blood pressure and higher insulin sensitivity. The AHA recommends at least 150 minutes of moderate-intensity exercise per week like taking a brisk walk in the neighborhood, going for a bike ride, or doing yard work.

2. Reduce stress.
Studies suggest that meditation and mindfulness can help improve everything from your stress levels and blood pressure to your sleep quality and emotional health. Having a furry friend around could also help lower your blood pressure, as well as improve your physical and emotional health by helping you stay more active and social.

3. Get good sleep.
If you’ve ever had a night of poor sleep, you already know the many ways that puts you in a slump. Sleep issues like not sleeping enough, sleep apnea, and insomnia can increase the risk of obesity, high blood pressure, Type 2 diabetes, stroke, and coronary heart disease. Regular exercise, limited screen time before bed, and a consistent sleep schedule can all help improve your sleep. 

Quitting smoking and drinking alcohol in moderation have both been linked to higher levels of good cholesterol. For alcohol, the CDC recommends limiting your intake to 1 drink per day for women and 2 drinks per day for men. 

To learn more about ways to keep your heart healthy, you can also tune into the American Heart Association podcast that covers everything from managing cholesterol to practicing meditation. But before you go about making any major lifestyle changes or if you have concerns about your heart health, it’s important to first consult with your doctor to decide what’s best for you.

It’s important to be your own advocate when it comes to your health and we’re here to support you with exceptional pharmacy care every step of the way. If your doctor prescribes cholesterol-lowering medications or other heart medications, our pharmacists would be happy to walk you through dosage instructions and answer your questions. We’ll also help you get the lowest price by looking for any available savings, as well as deliver your medications to your home for free. Simply tell your doctor to send your new prescription to Alto or contact our care team, and we’ll transfer your existing prescriptions for you.

The health of your gut can impact everything from your mood to your immunity. Here’s what you need to know and how you can keep your gut healthy.

Why Gut Health Is Key (and How To Improve Yours)

You may have noticed in recent years that the topic of gut health seems to come up a lot more in conversation and health news. Why is that? Over the past decade, scientists have been learning that your gastrointestinal (GI) system—of which your gut is a key part—does a lot more than just move food through your body. And that the health of your gut can impact everything from your mood to your immunity. Here’s what you need to know and how you can keep your gut healthy.

Gut Health 101: What It Is and Why It’s Important

Your body is full of trillions of microorganisms that make up your microbiome. Many of these microorganisms are bacteria. Some are harmful and associated with disease, while others are beneficial and key to your health. The ‘gut microbiome’ refers to the bacteria that live in the part of your GI tract where digestion happens—your large and small intestines—where, at any given time, we have between  300 and 500 different species of bacteria living. 

While everyone’s microbiome is unique, a general indicator of a healthy one is having a diversity of bacteria. In unhealthy people, scientists have observed much less diversity although they don’t know for certain which comes first—the bacteria or the disease. 

Inflammation, which studies point to as the root of many diseases, is kept in check in the gut. When the balance of your microbiome gets out of whack, inflammatory bacteria can take charge and, via metabolites, spread inflammation throughout your body. This can affect your brain, heart, and immune system function as well as your skin, weight, and ability to absorb nutrients. 

Having a healthy gut, on the other hand, has been linked to a stronger immune system, reduced symptoms of depression, lower risks of heart disease and certain cancers, as well as reduced symptoms of arthritis. 

So how do we keep our gut healthy? As with many other aspects of health, it largely boils down to the foods we eat and the lifestyle choices we make. Other factors like medication and emotional stress could also play a role. 

To start improving your gut health, it’s helpful to first look at what might be wreaking havoc on your microbiome. While there are many different symptoms that could point to an unhealthy gut, here are the most common.

Upset stomach
Signs of an upset stomach can include gas, bloating, constipation, diarrhea, and heartburn. When your gut is in balance, these symptoms should reduce, since your gut will have an easier time digesting and eliminating your food.

Poor sleep (or constant fatigue)
Serotonin, the sleep and mood hormone, is mainly produced in the gut. An imbalance in your gut can impair serotonin production and affect the quality of your sleep. 

Weight changes
Poor gut health can affect your body’s ability to absorb nutrients, regulate blood sugar, and store fat. Decreased nutrient absorption can result in the urge to overeat and unintentional weight gain. On the other hand, a bacterial overgrowth in the small intestine could cause weight loss.

Skin irritation
When your gut is inflamed, certain bacteria and toxins can leak out into the body, which could irritate your skin.

Autoimmune conditions
As mentioned earlier, research suggests that an unhealthy gut can lead to an inflammatory response in the body and affect your immune function. This could make you more susceptible to autoimmune diseases like Type 1 diabetes and celiac disease where the body attacks itself rather than harmful invaders. 

Food intolerances
It’s theorized that food intolerances can result from an imbalance in the gut. When you’re intolerant to a certain food, you may experience symptoms like bloating, gas, abdominal pain, and nausea.

A high-sugar diet
Sugar, often linked to inflammation in the body, can decrease the amount of good bacteria in the gut. This can cause more sugar cravings, making the situation worse.

You don’t necessarily have to keep your gut under a daily microscope, but following some general health practices—from keeping a balanced diet to getting a good night’s sleep—can go a long way. Your healthcare practitioner can also give gut health recommendations. Here are some common lifestyle choices that research shows can improve gut health. 

Chronic stress can wreak havoc on your whole body, including your gut. Some ways to reduce stress can include exercise, meditation, yoga, connecting with friends or family, and decreasing caffeine consumption.

Having a good pre-bed routine can be as important as the sleep itself. Your pre-bed routine could include minimizing screen time and exercise. In terms of the ideal amount of sleep to log, the National Sleep Foundation has recommendations based on your age. 

3. Avoid smoking
Studies have found that smoking can increase the amount of potentially harmful bacteria in your gut, while decreasing the amount of good bacteria. It’s also been shown to affect heart and lung health, as well as increase your risk of cancer. 

Water helps everything from digestion to carrying nutrients to your cells. And it can help maintain the balance of good bacteria in your gut. Drinking at least four to six cups a day is recommended. 

5. Take a probiotic or prebiotic
Probiotics are live, good bacteria that can come in pill form or from foods like yogurt. Though the science is still out on the extent of the pills efficacy, there seems to be a general consensus that adding a probiotic can be a good idea to help restore your gut’s balance. Prebiotics are the food that probiotics can eat and are usually fiber-rich. Having prebiotics in your gut can help promote the growth of the good bacteria. 

6. Exercise regularly 
Working out may help increase gut health by growing the diversity of good bacteria in your gut. How much should you exercise? For general adults, the recommendation is at least 150 minutes a week or 20 minutes per day. 

Minimize the amount of foods in your diet that are processed or high in sugar or fat—all of which can lead to increased inflammation in the body. When it comes to gut-healthy foods, diversity is key. Here’s what studies show are best for your gut:

Fiber-rich foods like legumes, beans, peas, oats, bananas, asparagus, and berries

Fermented foods like kimchi, sauerkraut, yogurt, kombucha, tempeh, miso, and kefir

Garlic and onion which may also help minimize the risks of certain cancers as well as boost the immune system

Collagen-rich or collagen-boosting foods like salmon, bone broth, mushrooms, egg whites, and cashews

Gut health can be key to helping everything from your brain to your immune system function properly. To keep your gut microbiome healthy, a key place to start is with a balanced diet as well as healthy lifestyle practices. Even though we can’t see our gut, there are many symptoms that can help let us know when ours is out of balance and needs some attention. 

If you are concerned about the potential effects of your medications on your gut health, talk to an Alto pharmacist. Our team of patient care pharmacists are ready to help whenever health questions come up. Reach out any time via text, phone call (1-800-874-5881), or in-app messaging.

Why Gut Health Is Key (and How To Improve Yours) 

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

Our mission and diversity work are tied together with one word from our mission -- everyone. Too often, only those with significant resources access the best and benefit from innovation in healthcare. We see it everyday in the data. Too many among us continue to struggle with solvable challenges, in our own wellbeing and in the larger healthcare system. These statements and environments have existed in the workplace as well, influencing the products, services, and policies that steer how the organization works for all of us.  Our work is to make Alto different.  Our work is to build and sustain an inclusive culture.  Our work is to attract, develop, reward and retain talent from all the communities we serve as patients and build a product that supports everyone. 

Today marks another step in our diversity, equity, and inclusion journey as we release our first annual diversity report. We share it because this work is central to our mission and in doing so, we use transparency to hold ourselves accountable, as well as hopefully play a part in raising expectations and norms throughout the healthcare and technology industries.

In 2020, across the company we saw a 13ppt increase in women and 7ppt increase in underrepresented groups (Black, Hispanic/LatinX and Native professionals).

As for women in leadership, we saw increases of 3ppts in Women Managers and 1ppt in Product, Engineering and Design driven by both hiring and promotion. At the leadership level, 32% of leaders identify as women.

In 2020, we saw 10ppt increase across our underrepresented managers to 13% Black, 16% Hispanic/LatinX, 2% Native/Indigenious.  In the leadership group, we saw an 8ppt increase to 15% Black and 2% Hispanic/LatinX. 

In 2020, we also established our Alto Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives. We’ve formed the Advisory Board to support our leadership as we navigate the regulatory landscape, launch new features to modernize the pharmacy experience, and adhere to the highest standards of operational excellence and patient care.  

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College, one of the nation’s oldest and largest private historically Black academic health sciences centers. He received his Bachelor’s degree from Harvard University, his Ph.D. in immunology from Oxford University as a Rhodes Scholar, and his medical degree from Johns Hopkins School of Medicine. He was the first Black American in the 125-year history of Johns Hopkins School of Medicine to earn full professorship with tenure and is internationally known for his influential HIV research.

Jennifer Kent served as the Director for the California Department of Health Care Services, where she led the second largest public healthcare system in the nation, with an annual budget of over $100B and serving over 13 million Californians. She oversaw the administration of 24 managed care plans as well as 56 county behavioral health plans. She has also held leadership roles in the Health & Human Services Agency, Governor's Office and has experience in the private sector as a lobbyist, consultant, and association executive. She has more than 15 years of health administration and policy experience in California.

Alto created our DEI strategy with our team aligned to four pillars – Hire, Include, Develop, and Invest.  Each pillar's actions tie to our people and our business. This means the return on investment is clear and goals are aligned to business outcomes.

Medical Health Care Premiums and Part Time Health Care Benefits in SF: 

In order to increase access and affordability to critical health-care services, we asked our broker to offer a special mid-year open enrollment 2020, reducing premiums for most plans by 5%. We reduced out-of-pocket maximums and speciality office visits by an average of 37%. We reduced co-insurance as well as costs for labs, x-Rays, and emergency room visits for our Cigna plan by 50%. Finally, prescriptions copays were reduced by 25% for Brand medications and 75% for Generic prescriptions. This benefits the employee with direct access to care and a better employee experience as compared to direct contribution to the city fund.

We increased our paid parental leave across all US locations to 8 weeks (up from 6 in 2020) for all parents requesting leave as of January 1st.  Throughout 2020 parents and other caregivers were impacted significantly as schools, daycare, and caregivers were closed, isolated, or unable to rely on pre-covid support. We offered laptops to parents who couldn’t afford them for each child to participate in remote learning.  We offered expanded benefits above and beyond FFCRA. Finally, we offered paid sessions for remote learning, tutoring, and experiences for parents and caregivers.

Finally, in December we launched Modern Health with 6 paid coach/therapy sessions and access to a digital wellbeing library and resources to all Altoids.

We launched six ERGs in 2020. Formalizing the work of our original Diversity Committee into six groups: Umoja (Black), Auténtico (LatinX/Hispanic), Women, Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents. These groups are focused on building community with both those who identify and allies. They support our education, development and investment in our communities. Each has been given a budget, an executive sponsor, and access to other company resources.

We recognized as a leadership team that we needed to educate ourselves. We were not going to rely on those from underrepresented communities to educate us. We embarked on four three-hour sessions focused on learning about diversity and inclusive language, naming our privilege, and starting the work each of us wanted to do. It was only after these sessions, with clear self-awareness and awakening; that began the work of empowering other leaders -- managers and other Altoids on this journey. There is more work to be done, as Neil Frye, Chief People Officer, mentioned in his blog post in late 2020 -- this is not a sprint, nor is it a marathon; it is life-long work.

Focus on Latinx Senior Manager to VP talent; with targeted outreach, activation and networking for opportunistic and open hiring

Expand employee resource group events throughout the year supporting inclusive environment, educating and investing in our communities

Get to full participation in DEI Workshops and launch additional sessions like What’s My Privilege and Moving to Action across the company

Explore new partnerships with Community & Higher Ed Institutions (i.e. Historically Black Colleges and Universities, Hispanic Serving Institutions, etc.)

2020 Diversity, Equity & Inclusion Report

Justin Moy, Senior Software Engineer at Alto, explains how the engineering team developed a staging environment strategy that could keep up with our growing organization.

Creating Sandboxes: How to Make It Easy for Your Engineering and Product Teams

When we formed our Infrastructure team in 2020, our charter centered on scale, reliability, and the developer experience. Our first priority? Developing a staging environment strategy that could keep up with our growing organization.

Initially, we had a set of command-line tools for staging environments that could be run from an engineer’s workstation. However, this approach required significant manual effort to create and manage an environment which led to inconsistencies like outdated data and lack of full application coverage and integration. The required workstation dependencies and maintenance added to the overhead. These tools were also different from the ones used to create a production environment, causing drift between the two.

To address these issues, we focused on improving our tooling to create consistent and reproducible results for both our staging and production environments. Here are the five steps we took to get there:

Luckily, we were already here. Our deployment process involved creating and deploying Docker containers and using a Procfile to run specific parts of our applications (think separating out web and workers). Packaging our applications as immutable Docker images allowed us to ship consistent and portable code. These images are run as containers which can be executed on separate hosts and scaled independently of each other.

We wanted to increase our observability, mature our internal monitoring, and maintain our infrastructure in a more consistent and reproducible manner. Kubernetes, and its automated container orchestration (deployment, scaling, and management), allowed us to accomplish all of the above goals.

It was easy for us to get started in Kubernetes thanks to Kind, which allowed us to run clusters locally. This increased development speed and reduced the friction of learning a new external provider.

Helm makes it easy to manage packaged applications in Kubernetes. Some community-provided applications include: NGINX for load balancing and reverse proxying HTTP and other traffic; Prometheus and Cortex for metrics, monitoring, alerting, and dashboarding, Loki for logs; and Sentry for exceptions.

In order to ease the integration with other infrastructure components, enable rapid deployment, and, most importantly, provide us with the consistency and reproducibility we wanted, we created and deployed Helm charts for our applications.

From here, we could stamp out our applications for developer use in sandbox environments: complete end-to-end environments, separate from production, that enable engineers to rapidly develop and test their code. And if an engineer is working on multiple features, they can spin up multiple sandbox environments and manage their applications and data independently of each other. Victory!

We had already created pipelines in Concourse to automatically deploy and upgrade our infrastructure Helm charts. To eliminate the manual toil of spinning up new environments and to reduce the friction around sandbox adoption for our engineers, we extended these automated pipelines by building a Git-driven continuous deployment pipeline. When an engineer created a commit to a repo defining the state of a sandbox, our Concourse job would apply these changes.

At this point, we could deploy environments that resembled production but were separate from production and other sandbox environments. They connected to the rest of our observability stack, including metrics, logs, traces, and exceptions.

As we prepared to scale to the rest of the product and engineering organization, we focused on the following ideas: further reducing manual toil, removing barriers to entry, reducing cost, and optimizing the development workflow. The diagram below shows our sandbox architecture.

In Kubernetes, an operator acts on custom resources in order to automate a task or set of tasks. The custom resource allows us to create a well-defined entity and extend configurability options to users. The operator allows us to customize individual sandbox environments based on changes to the custom resource.

We utilized Kubebuilder to create our operator and CRD (custom resource definition). Kubebuilder was a great starting point and provides tools to ease rapid development of a new operator.

Using this pattern, we could easily perform CRUD operations (create, read, update, delete) on a custom resource using standard tools like kubectl, and the operator would handle updating our deployments in Kubernetes. These updates could include: updates to application configuration, deploying a new Docker container, injecting different secrets, etc. This flexibility allows for testing of many different scenarios like: developing a new feature, reproducing a bug, upgrading frameworks, and security and load testing.

Increase adoption by removing barriers to entry (admin web UI)

We built a web UI so users would be able to deploy sandboxes intuitively and easily without extensive knowledge of the underlying tools. The web UI interacts with our custom resource and lets the operator handle updates. It allows our teammates—both engineers and non-engineers—to easily spin up their own environments for development, demo, or training purposes without modifying production data.

In addition, we show helpful information about a sandbox to a user. This includes links to each of our applications; pre-filtered logs, metrics, tracing, and exceptions; and commands to connect to specific applications to ease debugging.

Because the sandbox environments are integrated with our monitoring stack, we have the full metrics and logging that we expect from our applications. We created an autoscaler service that performs queries against this information and scales our sandbox environments up and down. We’re able to decrease our costs by over 90% when these environments are not in use and are able to quickly scale them back up when they are being used.

Optimize the development workflow (image updater)

An additional feature we built into our sandbox environment is the ability to follow a feature branch in our applications. When an engineer pushes a commit to a pull request in Github, a corresponding sandbox will automatically update to this commit. This reduces several manual steps in the development workflow and allows engineers to test their code in near-to real time.

Sandbox environments have made an impact on the engineering organization and beyond.

Engineers can quickly desk check new code in a production-like environment during code reviews.

Shared sandboxes reduce the blast radius of bug bashes.

Non-engineers can spin up sandboxes to demo or provide training on features without impacting production data via the Admin UI. This has proven particularly useful for Product Managers and Designers on the team to be able to play with product features and better understand how they work in order to suggest improvements.

Teams have built use case scenarios into their applications. This allows easy reproducibility of critical paths and functionality.

With these five steps—Containerize, Kubernetes-ize, Helm-ify, Automate, Optimize—we’ve laid the foundation for deploying all of our environments in an automated and consistent manner. In addition to applying many of our learnings to improve our production environment, we successfully built core infrastructure that our engineers, product managers, and designers use each month to test their changes and reduce production downtime.

Interested in learning more about engineering at Alto? Follow us on LinkedIn. 

Chronic obstructive pulmonary disease (COPD) is a long-term inflammatory condition that obstructs the airflow from the lungs. Here’s what you need to know about keeping your lungs healthy to avoid or manage COPD. 

Understanding Chronic Obstructive Pulmonary Disease (COPD)

The delicate, branching structures of the lungs bear a striking resemblance to trees. The air you breathe travels down your windpipe, or trachea, and enters the lungs through two large tubes known as bronchi. Just like the roots and limbs of a tree, these tubes divide again and again into smaller bronchioles before finally ending in clusters of tiny air sacs called alveoli—what you might consider the leaves. 

Chronic obstructive pulmonary disease (COPD) is a long-term inflammatory condition that obstructs the airflow from the lungs and makes it difficult to breathe. Although it's the third leading cause of death in the U.S., the good news is that it can be prevented and treated to slow the progression and maintain quality of life. Here’s what you need to know about keeping your lungs healthy to avoid or manage COPD. 

COPD refers to a group of progressive lung diseases, meaning the condition becomes worse over time. The most common are emphysema and chronic bronchitis, and many people with COPD have both of these conditions. 

Emphysema destroys the fragile air sacs in the lungs, which impairs the airflow. The air carrying carbon dioxide out of the body cannot be adequately expelled and some remains trapped in the lungs. Fresh, oxygen-rich air is then blocked from entering the lungs, causing gradually worsening shortness of breath, even while at rest.

According to the Mayo Clinic, most people with emphysema also have bronchitis, which causes inflammation and narrowing of the bronchial tubes. With bronchitis, mucus builds up in the lungs, spurring a persistent cough. 

The CDC reports that sixteen million Americans have trouble breathing due to COPD. However, they estimate that the actual number includes millions more who have not yet been diagnosed. 

In the vast majority of people with COPD, lung damage is caused by cigarette smoking. According to the COPD Foundation, about 90% of people with COPD are current or former smokers. However, damage can also be caused by long-term exposure to irritating gases or particulate matter, including air pollution and workplace exposure to dust, smoke, or fumes. 

An estimated five percent of people with COPD have a deficiency in a protein known as alpha-1-antitrypsin, which causes the lungs to deteriorate and can also affect the liver. People with severe asthma can also progress into COPD. 

The most telling—and distressing—symptom of COPD is difficulty breathing. According to the Mayo Clinic, another major symptom is a constant cough that produces a lot of mucus. Additional symptoms may include chest tightness, wheezing, frequent respiratory infections, and fatigue. Severe COPD can cause swelling in the ankles, legs, and feet and weight loss. 

As a progressive disease, symptoms often begin mildly and may be confused for the common cold. But rather than clearing up after a week or two, the coughing and shortness of breath will continue to worsen over time and make daily activities more difficult. 

Unfortunately, by the time COPD symptoms appear, there may already be significant lung damage. Symptoms will continue to escalate, particularly if smoking or exposure to lung irritants continues. With proper intervention and treatment, however, most people with COPD can slow the disease’s progression and maintain their quality of life. 

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