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Business Combinations, Goodwill and Intangible Assets - Purchase Price Allocation (Details) - USD ($)
$ in Thousands
Dec. 31, 2018
Dec. 31, 2017
Dec. 22, 2017
Dec. 31, 2016
Business Acquisition [Line Items]        
Goodwill $ 349,984 $ 204,481   $ 186,770
Health Integrated, Inc.        
Business Acquisition [Line Items]        
Tangible Assets     $ 5,475  
Liabilities     (5,733)  
Goodwill $ 0   14,229  
Total purchase consideration     22,811  
Health Integrated, Inc. | Customer relationships        
Business Acquisition [Line Items]        
Intangible assets     6,760  
Health Integrated, Inc. | Developed technology        
Business Acquisition [Line Items]        
Intangible assets     1,510  
Health Integrated, Inc. | Trade names and trademarks        
Business Acquisition [Line Items]        
Intangible assets     $ 570