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Business Segment Information - Operating Results by Business Segment (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2015
Sep. 30, 2015
Jun. 30, 2015
Mar. 31, 2015
Dec. 31, 2014
Sep. 30, 2014
Jun. 30, 2014
Mar. 31, 2014
Dec. 31, 2015
Dec. 31, 2014
Dec. 31, 2013
Operating results by business segment                      
Managed care and other revenue $ 863,506 $ 809,249 $ 776,240 $ 748,650 $ 753,489 $ 703,020 $ 682,274 $ 829,591 $ 3,197,645 $ 2,968,374 $ 3,063,049
PBM and dispensing 405,237 380,833 381,367 232,318 228,970 220,150 205,740 136,884 1,399,755 791,744 483,268
Cost of care (587,816) (596,323) (568,288) (522,328) (506,090) (495,180) (481,617) (605,708) (2,274,755) (2,088,595) (2,232,976)
Cost of goods sold (381,817) (360,444) (361,409) (218,207) (212,905) (202,180) (192,566) (125,298) (1,321,877) (732,949) (455,601)
Direct service costs and other $ (205,901) $ (220,586) $ (191,455) $ (204,450) $ (202,814) $ (176,928) $ (179,034) $ (164,722) (822,392) [1],[2] (723,498) [1],[2] (619,546) [1],[2]
Stock compensation expense                 50,384 40,584 21,252
Changes in fair value of contingent consideration                 44,257 6,172  
Less: non-controlling interest segment profit (loss)                 (2,634) (5,087)  
Segment profit (loss)                 275,651 266,919 259,446
Operating segments | Healthcare                      
Operating results by business segment                      
Managed care and other revenue                 2,959,252 2,780,905 2,900,592
Cost of care                 (2,274,755) (2,090,352) (2,239,997)
Direct service costs and other                 (438,019) (420,092) (352,644)
Stock compensation expense                 2,556 2,899 3,171
Changes in fair value of contingent consideration                 (1,404) 38  
Less: non-controlling interest segment profit (loss)                 (2,439) (5,087)  
Segment profit (loss)                 250,069 278,485 311,122
Operating segments | Pharmacy Management                      
Operating results by business segment                      
Managed care and other revenue                 238,456 205,524 228,705
PBM and dispensing                 1,510,180 844,512 483,268
Cost of care                   (16,298) (59,227)
Cost of goods sold                 (1,427,680) (784,758) (455,601)
Direct service costs and other                 (265,661) (182,833) (128,427)
Stock compensation expense                 34,864 28,829 1,172
Changes in fair value of contingent consideration                 45,661 6,134  
Segment profit (loss)                 135,820 101,110 69,890
Corporate and Elimination                      
Operating results by business segment                      
Managed care and other revenue                 (63) (18,055) (66,248)
PBM and dispensing                 (110,425) (52,768)  
Cost of care                   18,055 66,248
Cost of goods sold                 105,803 51,809  
Direct service costs and other                 (118,712) (120,573) (138,475)
Stock compensation expense                 12,964 8,856 16,909
Less: non-controlling interest segment profit (loss)                 (195)    
Segment profit (loss)                 $ (110,238) $ (112,676) $ (121,566)
[1] Includes changes in fair value of contingent consideration of $6,172 and $44,257 for the years ended December 31, 2014 and 2015, respectively.
[2] Includes stock compensation expense of $21,252, $40,584 and $50,384 for the years ended December 31, 2013, 2014 and 2015, respectively.