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Revenue Recognition - Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2019
Sep. 30, 2019
Jun. 30, 2019
Mar. 31, 2019
Dec. 31, 2018
Sep. 30, 2018
Jun. 30, 2018
Mar. 31, 2018
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Disaggregation of Revenue [Line Items]                      
Total revenue $ 236,525 $ 220,143 $ 191,959 $ 197,756 $ 193,104 $ 149,947 $ 144,298 $ 139,714 $ 846,383 $ 627,063 $ 434,950
Transformation services                      
Disaggregation of Revenue [Line Items]                      
Total revenue [1]                 15,203 32,916 $ 29,466
Services | Transformation services                      
Disaggregation of Revenue [Line Items]                      
Total revenue                 15,203 32,916  
Services | Clinical solutions                      
Disaggregation of Revenue [Line Items]                      
Total revenue                 458,991 228,464  
Services | Administrative solutions                      
Disaggregation of Revenue [Line Items]                      
Total revenue                 $ 198,618 $ 264,104  
[1] See Note 18 for amounts related to related parties included in these line items.