Schedule of intangible assets (Detail) - USD ($)	9 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Intangible Assets, Gross	$ 144,476,000	$ 144,476,000
Accumulated Amortization	(53,713,020)	(40,942,442)
Intangible Assets, Net	90,762,980	103,533,558
Medicare License [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible Assets, Gross	1,994,000	1,994,000
Accumulated Amortization	0	0
Intangible Assets, Net	1,994,000	1,994,000
Network relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible Assets, Gross	109,883,000	109,883,000
Accumulated Amortization	(45,485,494)	(35,842,508)
Intangible Assets, Net	$ 64,397,506	$ 74,040,492
Network relationships [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	15 years	15 years
Network relationships [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	11 years	11 years
Management contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	15 years	15 years
Intangible Assets, Gross	$ 22,832,000	$ 22,832,000
Accumulated Amortization	(6,863,192)	(5,014,886)
Intangible Assets, Net	$ 15,968,808	$ 17,817,114
Member relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	12 years	12 years
Intangible Assets, Gross	$ 6,696,000	$ 6,696,000
Accumulated Amortization	(978,876)	(46,500)
Intangible Assets, Net	$ 5,717,124	$ 6,649,500
Patient management platform [Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	5 years	5 years
Intangible Assets, Gross	$ 2,060,000	$ 2,060,000
Accumulated Amortization	(343,333)	(34,336)
Intangible Assets, Net	$ 1,716,667	$ 2,025,664
Trade name[Member]
Finite-Lived Intangible Assets [Line Items]
Useful Life (Years)	20 years	20 years
Intangible Assets, Gross	$ 1,011,000	$ 1,011,000
Accumulated Amortization	(42,125)	(4,212)
Intangible Assets, Net	$ 968,875	$ 1,006,788