New practice

Drs. Aurora Leon and Joaquin Carral at their new practice, Monarca Health, on West Street in Keene.

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 or call 751-3010.

Olivia Belanger can be reached at 352-1234, extension 1439, or Follow her on Twitter @OBelangerKS.