Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2020	Mar. 31, 2019
Disaggregation of Revenue [Line Items]
Total revenue		$ 247,285	$ 197,756
Transformation services
Disaggregation of Revenue [Line Items]
Total revenue	[1]	5,238	3,353
Platform and operations services
Disaggregation of Revenue [Line Items]
Total revenue	[1]	209,900	147,292
Services | Transformation services
Disaggregation of Revenue [Line Items]
Total revenue		5,238	3,353
Services | Platform and operations services | Clinical solutions
Disaggregation of Revenue [Line Items]
Total revenue		159,836	96,631
Services | Platform and operations services | Administrative solutions
Disaggregation of Revenue [Line Items]
Total revenue		$ 50,025	$ 50,661

[1] See Note 18 for amounts attributable to related parties included in these line items.