CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Cash flows from operating activities:
Net (loss) income	$ (154,175)	$ 3,030	$ (2,056)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	218,537	172,390	161,011
Stock-based compensation expense	38,769	42,877	34,663
Excess tax benefits from stock-based compensation	0	(1,014)	(644)
Deferred taxes	(55,787)	(22,621)	(2,206)
Asset impairment charges	0	4,650	1,544
Impairment of and losses on long-term investments	165,290	0	0
Equity in net (income) loss of unconsolidated investments	(821)	7,501	2,100
Other losses, net	4,005	2,579	(614)
Changes in operating assets and liabilities (net of businesses acquired):
Accounts receivable, net	(99,431)	(17,826)	3,215
Prepaid expenses and other assets	13,820	13,765	17,614
Accounts payable	(18,014)	40,456	(11,953)
Accrued expenses	4,631	1,490	(22,974)
Accrued compensation and benefits	22,006	(4,106)	10,257
Deferred revenue	126,041	21,722	20,372
Other liabilities	14,544	(1,113)	(183)
Net cash provided by operating activities	279,415	269,004	211,579
Write-off of unamortized deferred debt issuance costs	0	5,224	1,433
Cash flows from investing activities:
Capital expenditures	(46,376)	(35,510)	(18,322)
Capitalized software	(138,895)	(102,472)	(49,264)
Cash paid for business acquisitions, net of cash acquired	(222,310)	(994,876)	(9,372)
Purchases of equity securities, other investments and related intangible assets	(5,606)	(21,185)	(215,786)
Other proceeds from investing activities	215	37	3,778
Net cash used in investing activities	(412,972)	(1,154,006)	(288,966)
Cash flows from financing activities:
Proceeds from sale or issuance of common stock	1,568	84	103,631
Proceeds from issuance of redeemable convertible preferred stock - Netsmart	0	333,605	0
Excess tax benefits from stock-based compensation	0	1,014	644
Taxes paid related to net share settlement of equity awards	(7,269)	(8,204)	(7,062)
Payments of capital lease obligations	(12,203)	(6,277)	(598)
Credit facility payments	(142,748)	(157,245)	(238,511)
Credit facility borrowings, net of issuance costs	374,698	823,535	284,161
Repurchase of common stock	(12,077)	(121,241)	0
Payment of acquisition financing obligations	(4,878)	0	0
Proceeds from sales of subsidiary shares to non-controlling interest	1,494	0	0
Net cash provided by financing activities	198,585	865,271	142,265
Effect of exchange rate changes on cash and cash equivalents	860	(532)	(1,178)
Net increase (decrease) in cash and cash equivalents	65,888	(20,263)	63,700
Cash, cash equivalents and restricted cash, beginning of period	96,610	116,873	53,173
Cash, cash equivalents and restricted cash, end of period	$ 162,498	$ 96,610	$ 116,873