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Business Segment Information - Operating Results by Segment (Details) - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2018
Jun. 30, 2017
Jun. 30, 2018
Jun. 30, 2017
Operating results by business segment        
Net revenue $ 1,810,923 $ 1,419,139 $ 3,616,000 $ 2,724,762
Cost of care (935,814) (583,264) (1,864,475) (1,065,318)
Cost of goods sold (558,419) (562,355) (1,118,084) (1,104,988)
Direct service costs and other (259,152) (231,372) (528,229) (452,858)
Stock compensation expense 10,439 11,371 18,085 21,511
Changes in fair value of contingent consideration 70 252 303 203
Less: non-controlling interest segment profit (loss)   (569)   (847)
Segment profit (loss) 68,047 54,340 123,600 124,159
Managed care and other        
Operating results by business segment        
Net revenue 1,215,340 821,699 2,435,103 1,551,039
PBM        
Operating results by business segment        
Net revenue 595,583 597,440 1,180,897 1,173,723
Operating segments | Healthcare        
Operating results by business segment        
Cost of care (935,814) (583,264) (1,864,475) (1,065,318)
Direct service costs and other (177,990) (145,914) (364,236) (284,882)
Stock compensation expense 2,742 3,106 5,692 5,765
Changes in fair value of contingent consideration 70 252 303 203
Less: non-controlling interest segment profit (loss)   (568)   (845)
Segment profit (loss) 43,896 30,018 89,773 77,259
Operating segments | Healthcare | Managed care and other        
Operating results by business segment        
Net revenue 1,154,888 755,270 2,312,489 1,420,646
Operating segments | Pharmacy Management        
Operating results by business segment        
Cost of goods sold (603,951) (595,446) (1,208,864) (1,167,283)
Direct service costs and other (70,941) (74,953) (146,527) (150,806)
Stock compensation expense 1,408 5,684 2,893 11,414
Segment profit (loss) 29,913 33,876 45,404 62,842
Operating segments | Pharmacy Management | Managed care and other        
Operating results by business segment        
Net revenue 60,603 66,659 122,910 130,839
Operating segments | Pharmacy Management | PBM        
Operating results by business segment        
Net revenue 642,794 631,932 1,274,992 1,238,678
Corporate and Elimination        
Operating results by business segment        
Cost of goods sold 45,532 33,091 90,780 62,295
Direct service costs and other (10,221) (10,505) (17,466) (17,170)
Stock compensation expense 6,289 2,581 9,500 4,332
Less: non-controlling interest segment profit (loss)   (1)   (2)
Segment profit (loss) (5,762) (9,554) (11,577) (15,942)
Corporate and Elimination | Managed care and other        
Operating results by business segment        
Net revenue (151) (230) (296) (446)
Corporate and Elimination | PBM        
Operating results by business segment        
Net revenue $ (47,211) $ (34,492) $ (94,095) $ (64,955)