An Alstead couple is launching a new primary-care practice in Keene this week, with a focus on upfront pricing and a closer patient relationship.
Dr. Aurora Leon and Dr. Joaquin Carral are holding a soft opening for Monarca Health on Thursday, at 340 West St., with an official launch set for November.
“We saw the need for patients to have a connection with their doctors,” said Carral, 39. “[A doctor] who can take an hour with them, that can do a home visit if they need, that they can send a text or email or a picture of a rash, and can answer right away.”
Monarca Health is a direct primary-care facility — a model that allows patients to pay a monthly fee directly to their provider for services, rather than the provider billing the patient’s insurance.
The model gained traction in the 1990s, and there are now more than 1,300 of these practices in 48 states and Washington, D.C., according to DPC Frontier, which tracks direct primary-care providers nationwide.
And in New Hampshire, where residents spent nearly $2,000 more than the national average on insurance in 2014, according to the latest data available from the Henry J. Kaiser Family Foundation, the movement is also growing.
Monarca Health is the fifth direct primary-care provider to open in the Granite State, following one in Peterborough, one in Concord and two in Portsmouth, according to DPC Frontier.
“We are trying to do a direct relationship with the patient, and to take away the third parties, like the hospital system or insurance companies that [have] different interests ... we want it to be as clear and direct with the patient as possible,” Carral said.
Direct primary care is a good option for physicians seeking to reduce administrative burdens and spend more time with their patients, according to the American Medical Association.
Before launching their own practice, Carral and Leon worked for five years at a community clinic in Willimantic, Conn.
Monarca Health will charge a single patient $60 per month and couples $108. The practice will also serve families at a discounted rate, with membership costs dependent on the number of people and their ages.
Carral and Leon added that patients are generally encouraged to carry a cheaper form of insurance in case they need surgeries or care from the emergency room — one of the limitations medical experts have cited about the direct primary-care model.
To meet patients’ needs during the COVID-19 pandemic, a telehealth-only membership will also be available soon, the practice’s website says. However, the couple is still encouraging in-patient visits, as only one patient will be seen at a time.
“The point is that it’s scheduled according to the patient’s needs, so we actually don’t have a waiting room because no one will be waiting,” said Leon, 37.
With the membership, patients can call, text, video-call or email Carral or Leon; have extended doctor’s visits, averaging about an hour; book an appointment within 48 hours; and attend classes on healthy cooking or altering chronic disease progression.
Additionally, memberships include simple procedures such as joint injections, sutures, Pap smears and cryosurgery. Patients will receive procedures that may cost more, such as labs, medical supplies or imaging referrals, at wholesale prices.
They said this offers more transparency for the patient.
Health care “is the only business in the country where you go and ask for a price, and you will never get a straight answer,” Carral said.
“We want them to know how much it will cost before they get the bill,” Leon added.
As well as being the only doctors at the practice, Carral and Leon will be the only employees. They said they will do everything from answering the phones and scheduling appointments to cleaning up the facility — all part of their effort to further cultivate their relationships with patients.
Monarca Health plans to serve about 400 patients, rather than the usual 2,000 most hospitals assign a single provider, Leon said.
“If the town needs more of this type of service, we will probably get another primary-care provider,” she said.
Ultimately, the couple said, they hope Monarca Health provides a healthy atmosphere for both the patient and provider.
“Happier doctors, happier patients,” Carral said.
For more information about Monarca Health, visit www.monarcahealth.com or call 751-3010.
Magical powers. A coming-of-age adventure. Redemption and repentance.
Although its themes are universal, a new children’s book, “Betsy Robin,” has a local flavor: Both the author, Zachary Benton, and illustrator, Mariah King, have connections to the Elm City.
The book is largely fantastical, featuring chatty animals, including an eponymous protagonist, in an autumnal setting that Benton said tries to capture the “magic” of New England. It follows the familiar arc of a supernaturally gifted student struggling to come to terms with those capabilities.
Benton explained that it was inspired by his experiences as a tutor at two Granite State elementary schools.
“Working in the public schools, I always [thought] it would be cool if there was a student that did something that you can’t explain,” he said.
Though lacking in supernatural powers, Benton, 32, has forged a whimsical career since graduating from Keene State College in 2010 with a degree in American Studies.
A singer and songwriter, he has hosted the O! Melodious Show, featuring music and sketch comedy, under his stage name, Melodious Zach, since 2016. Benton, who lived in Keene until moving to Clinton, Mass. this year, said the program, which has aired on Cheshire TV and other local stations, began as a live talk show with musical guests but has since incorporated more dramatic storytelling.
Several years after graduating from Keene State, Benton also began tutoring students at Franklin Elementary School in Keene. There, he got to know King’s mother, Kristen King, who worked at the school.
Benton said Kristen introduced him to her daughter’s artwork, which mostly consists of paintings and resin-based media, like sculptures.
Mariah King, 25, graduated from Keene High School in 2013 before attending the University of New Hampshire, where she earned a degree in fine and studio arts. In 2018, she moved to Concord to start her own art business, Kingly Krafts.
Benton reached out that year to propose collaborating on a children’s book. King said she agreed despite never having done illustrations. They quickly began working on their first book, “Atticus the Elf,” which explores how Santa Claus is able to travel around the world in a single night.
“He sent me the story, and I immediately fell in love with it,” King said.
She explained that Benton also shared his concept for “Betsy Robin” while the duo was still working on the first book. He began writing the story in November 2019, the same month that “Atticus the Elf” was published.
Despite already having an idea for “Betsy Robin,” Benton said the writing process was intermittent and difficult. It took him about seven months to finish a first draft, which he shared with King in June.
“With music, it’s so easy for me. It’s like a second language,” he said. “But with writing … the story’s [in your head], but you have to get it out intelligibly.”
Benton said he relied on several people, including King, to identify points of confusion or inconsistencies in the story. He explained that during the editing process, he tried to be objective and “pretend like he didn’t write it” — a technique he also uses while reviewing his music and other multimedia productions.
Still, there was no guarantee that King would illustrate the story how he imagined it. She and Benton discussed their respective visions, with King adding that neither wanted to force his or her own on the other.
“I’m not a writer at all, but I can read something and go, ‘OK, I can see this in my head’,” she said. “ … I want it to be perfect [for] how he sees it, but he’s really welcoming with my perspective.”
After illustrating “Atticus the Elf” by hand, King used the iPad drawing application Procreate for “Betsy Robin” — a substantial improvement, she said.
And while several aspects of the book suspend reality, she and Benton agreed that it offers very real lessons in tolerance and decency — for both children and educators.
“It’s definitely something that I think will speak to a lot of the readers, especially younger kids who maybe think they’re different when they’re growing up,” King said. “I think it is something that can be inspirational.”
Paperback copies of “Betsy Robin” can be purchased on Amazon starting today, and the electronic version is available for Kindle.
Rather than hiring a publishing company, Benton and King decided to use Kindle Direct Publishing, which is owned by Amazon. The self-publishing service eliminates the up-front cost of producing copies before they are sold and instead prints a single edition for each purchase of the book — though Amazon takes 40 percent of the price in royalties, Benton said.
He and King said they do not have expectations for how many copies will be sold but hope the book makes an impression on its readers.
“Once ‘Betsy’ is out, it’s going to be out for a long, long time, and that’s going to hopefully affect a lot of people,” Benton said. “It’s a positive thing that we have put out into the world, and that’s something always to be proud of.”