Accounts payable and accrued expenses (Detail) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Account Payable And Accrued Liabilities [Line Items]
Accounts payable	$ 3,786,381	$ 1,424,573
Specialty capitation payable	547,307	678,335
Subcontractor IPA risk pool payable	1,348,376	1,709,112
ACA payable	0	718,808
Professional fees	3,004,215	411,705
Deferred Revenue, Current	250,000	603,041
Accrued compensation	4,343,341	2,537,703
Accounts payable and accrued liabilities	$ 13,279,620	$ 8,083,277