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Business Segment Information - Operating Results by Segment (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Operating results by business segment    
Net revenue $ 1,805,077 $ 1,305,623
Cost of care (928,661) (482,054)
Cost of goods sold (559,665) (542,633)
Direct service costs and other (269,077) (221,486)
Stock compensation expense 7,646 10,140
Changes in fair value of contingent consideration 233 (49)
Less: non-controlling interest segment profit (loss)   (278)
Segment profit (loss) 55,553 69,819
Managed care and other    
Operating results by business segment    
Net revenue 1,219,763 729,340
PBM    
Operating results by business segment    
Net revenue 585,314 576,283
Operating segments | Healthcare    
Operating results by business segment    
Cost of care (928,661) (482,054)
Direct service costs and other (186,246) (138,968)
Stock compensation expense 2,950 2,659
Changes in fair value of contingent consideration 233 (49)
Less: non-controlling interest segment profit (loss)   (277)
Segment profit (loss) 45,877 47,241
Operating segments | Healthcare | Managed care and other    
Operating results by business segment    
Net revenue 1,157,601 665,376
Operating segments | Pharmacy Management    
Operating results by business segment    
Cost of goods sold (604,913) (571,837)
Direct service costs and other (75,586) (75,853)
Stock compensation expense 1,485 5,730
Segment profit (loss) 15,491 28,966
Operating segments | Pharmacy Management | Managed care and other    
Operating results by business segment    
Net revenue 62,307 64,180
Operating segments | Pharmacy Management | PBM    
Operating results by business segment    
Net revenue 632,198 606,746
Corporate and Elimination    
Operating results by business segment    
Cost of goods sold 45,248 29,204
Direct service costs and other (7,245) (6,665)
Stock compensation expense 3,211 1,751
Less: non-controlling interest segment profit (loss)   (1)
Segment profit (loss) (5,815) (6,388)
Corporate and Elimination | Managed care and other    
Operating results by business segment    
Net revenue (145) (216)
Corporate and Elimination | PBM    
Operating results by business segment    
Net revenue $ (46,884) $ (30,463)