CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 431	$ 11,452
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	30,708	30,407
Non-cash interest expense	326	307
Non-cash stock compensation expense	9,607	7,646
Non-cash income tax provision (benefit)	(250)	62
Non-cash amortization on investments	(192)	809
Changes in assets and liabilities, net of effects from acquisitions of businesses:
Accounts receivable, net	(23,804)	(87,178)
Pharmaceutical inventory	(6,333)	3,067
Other assets	(10,835)	(37,914)
Accounts payable and accrued liabilities	20,399	26,529
Medical claims payable and other medical liabilities	19,671	107,569
Contingent consideration	(1,609)	233
Tax contingencies	83	448
Deferred credits and other long-term liabilities	(2,889)	17,685
Other	111	(90)
Net cash provided by operating activities	35,424	81,032
Cash flows from investing activities:
Capital expenditures	(12,642)	(19,502)
Acquisitions and investments in businesses, net of cash acquired	(320)
Purchases of investments	(172,766)	(142,886)
Proceeds from maturities and sales of investments	128,748	118,999
Net cash used in investing activities	(56,980)	(43,389)
Cash flows from financing activities:
Payments to acquire treasury stock	(4,124)
Proceeds from exercise of stock options	2,045	16,897
Payments on debt, finance lease and deferred financing obligations	(7,323)	(55,895)
Payments on contingent consideration	(6,247)
Other	(1,702)	(3,051)
Net cash used in financing activities	(17,351)	(42,049)
Net decrease in cash and cash equivalents	(38,907)	(4,406)
Cash and cash equivalents at beginning of period	272,308	398,732
Cash and cash equivalents at end of period	233,401	394,326
Non-cash investing activities:
Assets acquired under finance leases and deferred financing	$ 3,302	$ 51