Goodroot builds healthcare companies. Over the past decade, it’s incubated a portfolio of companies working on some of the industry’s hardest problems — pharmacy benefits, payment integrity, patient affordability, regulatory compliance, benefits administration.
What most of those companies had in common, for years, was where they went for marketing: an internal team that took them through their entire lifecycle: launches, brands, rebrands, mergers, acquisitions, quietly doing agency-caliber work that nobody outside the portfolio could buy.
Word got around anyway. Outside companies kept asking if that team could support their marketing efforts too, and for years, the answer was always no.
A year ago, that changed.
The internal team became Sixfold, a healthcare marketing agency that now serves clients across the industry. We sat down with Goodroot founder Mike Waterbury to talk about how it happened, and why nothing Sixfold has accomplished since has surprised him.
Was there a specific moment — a campaign, a presentation, a conversation — where you looked at this team and thought, “they’re too good to stay internal”?
The foundation was built early. From the beginning, I saw a real gap in healthcare: a lack of quality marketing and branding work for both established companies and new ones.
I had experienced that gap myself when I started RemedyOne and went looking for marketing support. Everywhere you looked, competitors were saying the same things. The messaging across the industry was confusing. Even people inside healthcare couldn’t always tell you what a company actually did.
When you brought in an outside agency, you could spend months teaching them the business. It’s difficult to capture the essence of a healthcare company without that level of understanding, and most agencies never fully get there. So the need for something different was always apparent.
But there wasn’t one defining moment when I realized this team could be that something. There were many.
Goodroot’s own rebrand was one of them. I watched the team take on our positioning and messaging and come out the other side with something much sharper than what we started with.
The merger of AlignRx and CoeoRx into Navion was another. It was a complex engagement with very little direction or involvement from me, but the team grasped the market, nailed the messaging and executed flawlessly from start to finish. The look and feel they created for Navion was unlike anything I had seen in the pharmacy space. Nobody else’s brand looked like it. That’s the kind of work that changes how you see a team.
The sale of ClearFile belongs on that list, too. The buyer was a private equity firm that scrutinized the return on every dollar, including marketing spend, and they recognized the value of the work right away.
Any one of those moments would have been convincing. Together, they weren’t really a single “aha.” They were proof building on proof.
You’ve had people pitch you on ideas like this before that didn’t pan out. What made Sixfold different?
Honestly, it was one of the easier decisions I’ve made because I already had more than seven years of evidence.
This wasn’t a new idea I had to take on faith. It was a business that already existed, already worked and already produced great results. I had experienced it as a customer, and I was blown away.
Then there was Liz Chasse, Sixfold’s CEO. When you think about what makes an entrepreneur successful. The ability to lead, understand a business and bring real passion to the work—I saw all of it in her.
It came down to two things I already had proof of: a product I trusted and a leader I trusted. That combination made the decision easy.
How did the actual conversation happen — who came to whom first?
It took a while, the way these things usually do. I wanted to start my own business for five or six years before I actually did it, so I understand that timeline.
With Liz, it started casually, almost as a joke.
“When are you going to start that world-class marketing agency?”
“Don’t you think you could do a better job than the agency that just did this for another company?”
That kind of thing.
It became more serious in stages, helped along by the fact that companies outside Goodroot kept asking whether the team could work with them, too.
At some point, saying yes stopped being a hypothetical and became the obvious next step.
What did you risk by taking the team external? Was there a version of this where you said no?
The Goodroot companies had grown accustomed to a level of attention and quality that’s difficult to find anywhere else.
Once Sixfold began serving external clients, there was some concern within those companies that they would lose priority or that their work would get pushed down the list. That was the real risk.
But it didn’t happen. The team built Sixfold in a way that preserved the level of service the Goodroot companies had always received. They continue to deliver for those companies with the same strategic attention and quality they always have.
What does Sixfold understand that most agencies don’t?
Healthcare is hard to talk about honestly.
There are real problems: costs that are too high, inefficiencies and gaps in quality. What Sixfold does differently is simple to say and hard to replicate: they know the industry.
Not at the surface level. They know the players, the brokers, the PBMs, the consultants, how the money actually moves and, frankly, where the B.S. is.
They’ve lived inside these businesses. When a client explains what they do, there isn’t a translation problem. The team gets it. They can reach the real story faster, including the difficult parts, because they don’t need the industry explained to them.
That also comes from Goodroot. We were transparent about what was actually broken from day one. That’s just how Goodroot operates. It created an environment where the team became comfortable telling the truth, even when the truth was complicated.
A year in — has anything Sixfold accomplished actually surprised you?
Honestly, no.
They’re winning new work, signing clients across the industry and making those clients happy. But this team was part of the magic at Goodroot long before Sixfold launched.
I’m proud of where they are now, but I’m not surprised by it.
I’ve known what this team was capable of for years. Now the rest of the industry gets to see it, too.
