A full-service digital pharmacy app covering prescriptions, payments, insurance savings, and human pharmacist care, redesigned around patient confidence and clarity, reducing per-order costs by $2.

Alto is a full-service digital pharmacy covering prescriptions, payments, insurance savings, fulfillment, and direct pharmacist care. Alto Assistant is the patient-facing layer inside the mobile app where patients ask questions, report concerns, and request help. This project focused on medical questions: the most expensive, most complex, and most clinically sensitive category of inbound message.

In 2022, Alto's mobile app received an average of 3,200 patient messages per day, each one generating a support ticket. Many were non-clinical or resolvable through self-service, but all of them required Care Ops to triage. Medical questions required pharmacist involvement on top of that. At Alto's shipment volume, every dollar of unnecessary handling cost added up fast.

Messages arrived as unstructured text with no context, no categorization, and no expectation setting. Care Specialists spent time triaging messages that didn't need them. Pharmacists handled expensive escalations without enough upfront context. Patients were left uncertain about response times and next steps.

The business had a clear target: reduce Care Cost per Shipment from $16 to $10. Medical questions were the most expensive category, each escalation required a Care Specialist and then a Specialty Pharmacist, often duplicating effort across handoffs.

Three priorities shaped the work. Reduce Care Cost per Shipment by decreasing unnecessary inbound messages. Limit avoidable escalations to pharmacists through better upfront context. And set clearer expectations for patients around response time and next steps.

For patients, the goal was simpler: make it easier to ask a medical question confidently, understand what happens next, and get qualified help without unnecessary back-and-forth.

After auditing a week of inbound messages, the team grouped them into six core topics. That bucketing made it possible to tackle each problem independently. This case study focuses on medical questions, the most operationally expensive category.

Research surfaced a consistent tension between patient uncertainty and internal operational risk. Patients often didn't know how to frame medical questions, frequently raised more than one concern at a time, and defaulted to messaging as a catch-all. Internally, Care Ops and Pharmacy worried about being overwhelmed by unfiltered volume or becoming bottlenecks when escalations spiked.

Those findings made one thing clear: asking patients to self-diagnose or pick the right category would add friction and undermine trust. The solution needed to guide without gatekeeping.

Before narrowing into specific interaction patterns, the team explored a wide range of visual and structural directions to understand how guidance, tone, hierarchy, and information density could affect patient confidence.

As concepts narrowed, two variants were tested with 9 patients to pressure-test the boundary between operational efficiency and patient trust.

Testing confirmed that small interventions could meaningfully improve clarity. A recurring theme also emerged: several patients wanted to see relevant medication information immediately, a capability that already existed in the app but was hard to discover. That insight shaped the North Star direction.

Three directions were developed and reviewed with Product, Pharmacy, and Care Ops leadership. Each explored a different balance between structure, flexibility, and clinical risk.

One specific flow explored during this phase was a direct-to-pharmacist routing path for high-confidence medical questions. The goal was to eliminate the Care Ops handoff entirely for cases where pharmacist involvement was clearly required from the start.

A full redesign of the medical questions flow didn't ship during this phase. What did ship were targeted improvements to how Care Specialists handled patient conversations inside Wunderbar, alongside patient-facing flow improvements that launched in May 2022 to a 10% controlled cohort.

The exploratory work aligned Product, Care Ops, and Pharmacy around shared principles for future iteration, creating clarity on what a safer, more scalable system could look like when instrumentation and resourcing allowed.

The longer-term vision anchored the medical consultation journey around a medication selector, with clearer guidance, relevant subtopics, and self-service content layered on top. Patients would get help faster and with better context. The system would reduce unnecessary back-and-forth and downstream escalations. Several patients had surfaced this direction during testing, they wanted relevant medication information immediately, and the capability existed in the app but was too hard to find.

The feature launched in May 2022 following a 10% controlled cohort rollout, in line with Alto's release protocol for medical-context changes. The cohort allowed the team to monitor behavior and validate impact before full release. This case study shares platform-level metrics with the Alto Internal Tools work. Both were part of the same Alto Assistant system, the patient-facing and internal-facing sides of the same operational problem.