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Business Segment Information - Operating Results by Segment (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2017
Mar. 31, 2016
Operating results by business segment    
Managed care and other revenue $ 729,340 $ 676,461
PBM and dispensing revenue 576,283 440,561
Cost of care (482,054) (457,631)
Cost of goods sold (542,633) (415,459)
Direct service costs and other [1],[2] (221,486) (192,456)
Stock compensation expense 10,140 8,887
Changes in fair value of contingent consideration (49) (266)
Less: non-controlling interest segment profit (loss) (278) 165
Segment profit (loss) 69,819 59,932
Operating segments | Healthcare    
Operating results by business segment    
Managed care and other revenue 665,376 618,928
Cost of care (482,054) (457,631)
Direct service costs and other (138,968) (125,617)
Stock compensation expense 2,659 2,019
Changes in fair value of contingent consideration (49) (320)
Less: non-controlling interest segment profit (loss) (277) 169
Segment profit (loss) 47,241 37,210
Operating segments | Pharmacy Management    
Operating results by business segment    
Managed care and other revenue 64,180 57,577
PBM and dispensing revenue 606,746 470,234
Cost of goods sold (571,837) (443,949)
Direct service costs and other (75,853) (60,841)
Stock compensation expense 5,730 5,422
Changes in fair value of contingent consideration   54
Segment profit (loss) 28,966 28,497
Corporate and Elimination    
Operating results by business segment    
Managed care and other revenue (216) (44)
PBM and dispensing revenue (30,463) (29,673)
Cost of goods sold 29,204 28,490
Direct service costs and other (6,665) (5,998)
Stock compensation expense 1,751 1,446
Less: non-controlling interest segment profit (loss) (1) (4)
Segment profit (loss) $ (6,388) $ (5,775)
[1] Includes changes in fair value of contingent consideration of $(266) and $(49) for the three months ended March 31, 2016 and 2017, respectively.
[2] Includes stock compensation expense of $8,887 and $10,140 for the three months ended March 31, 2016 and 2017, respectively.