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Summary of Significant Accounting Policies - Significant Customers (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2017
Sep. 30, 2017
Jun. 30, 2017
Mar. 31, 2017
Dec. 31, 2016
Sep. 30, 2016
Jun. 30, 2016
Mar. 31, 2016
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Significant customers                      
Revenues $ 1,694,415 $ 1,419,406 $ 1,419,139 $ 1,305,623 $ 1,263,385 $ 1,292,132 $ 1,164,345 $ 1,117,022 $ 5,838,583 $ 4,836,884 $ 4,597,400
Florida Contract                      
Significant customers                      
Termination notice                 1 day    
Termination notice period without cause                 30 days    
Revenues                 $ 605,900 548,700 439,500
Iowa Contracts                      
Significant customers                      
Revenues                   13,500 530,300
Pharmacy Management | Customer A | Service                      
Significant customers                      
Revenues                 4,764 264,152 $ 324,809
Pharmacy Management | Customer B | Service                      
Significant customers                      
Revenues                 $ 346,405 $ 152,218