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Business Segment Information - Operating Results by Segment (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Sep. 30, 2017
Sep. 30, 2016
Operating results by business segment        
Managed care and other revenue $ 834,358 $ 751,589 $ 2,385,397 $ 2,127,911
PBM and dispensing revenue 585,048 540,543 1,758,771 1,445,588
Cost of care (569,306) (480,243) (1,634,624) (1,410,403)
Cost of goods sold (543,682) (509,673) (1,648,670) (1,362,062)
Direct service costs and other [1],[2],[3] (227,372) (229,094) (680,230) (635,627)
Stock compensation expense 10,323 9,176 31,834 27,573
Changes in fair value of contingent consideration (834) 313 (631) 510
Impairment of intangible assets       4,800
Less: non-controlling interest segment profit (loss) 788 (194) (59) (1,341)
Segment profit (loss) 87,747 82,805 211,906 199,631
Operating segments | Healthcare        
Operating results by business segment        
Managed care and other revenue 769,451 690,572 2,190,097 1,947,470
Cost of care (569,306) (480,243) (1,634,624) (1,410,403)
Direct service costs and other (143,550) (152,992) (428,432) (418,574)
Stock compensation expense 2,623 2,267 8,388 6,737
Changes in fair value of contingent consideration (834) 313 (631) 383
Impairment of intangible assets       4,800
Less: non-controlling interest segment profit (loss) 789 (189) (56) (1,325)
Segment profit (loss) 57,595 60,106 134,854 131,738
Operating segments | Pharmacy Management        
Operating results by business segment        
Managed care and other revenue 65,131 61,106 195,970 180,658
PBM and dispensing revenue 618,178 570,231 1,856,856 1,535,864
Cost of goods sold (575,327) (538,113) (1,742,610) (1,448,699)
Direct service costs and other (74,976) (66,475) (225,782) (191,402)
Stock compensation expense 5,680 5,368 17,094 16,338
Changes in fair value of contingent consideration       127
Segment profit (loss) 38,686 32,117 101,528 92,886
Corporate and Elimination        
Operating results by business segment        
Managed care and other revenue (224) (89) (670) (217)
PBM and dispensing revenue (33,130) (29,688) (98,085) (90,276)
Cost of goods sold 31,645 28,440 93,940 86,637
Direct service costs and other (8,846) (9,627) (26,016) (25,651)
Stock compensation expense 2,020 1,541 6,352 4,498
Less: non-controlling interest segment profit (loss) (1) (5) (3) (16)
Segment profit (loss) $ (8,534) $ (9,418) $ (24,476) $ (24,993)
[1] Includes changes in fair value of contingent consideration of $313 and $(834) for the three months ended September 30, 2016 and 2017, respectively, and $510 and $(631) for the nine months ended September 30, 2016 and 2017, respectively.
[2] Includes impairment of intangible assets of $0 and $4,800 for the three and nine months ended September 30, 2016, respectively.
[3] Includes stock compensation expense of $9,176 and $10,323 for the three months ended September 30, 2016 and 2017, respectively, and $27,573 and $31,834 for the nine months ended September 30, 2016 and 2017, respectively