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Fair Value Measurements - Contingent consideration rollforward (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Change in fair value    
Change in fair value of acquisition-related contingent consideration expense $ 13,521 $ 21
Acquisition related contingent consideration    
Change in fair value using significant unobservable inputs (Level 3):    
Balance at beginning of period 33,429  
Fair value of cash consideration paid (1,646)  
Adjustments to fair value measurement 13,521  
Balance at end of period 45,304  
Medliance    
Change in fair value    
Change in fair value of acquisition-related contingent consideration expense 6  
Payments of acquisition-related consideration 1,646  
Fair value of contingent consideration 0  
SinfoniaRx    
Change in fair value    
Change in fair value of acquisition-related contingent consideration expense 13,515  
Fair value of contingent consideration $ 45,304