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Business Segment Information - Operating Results by Segment (Details) - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2019
Jun. 30, 2018
Jun. 30, 2019
Jun. 30, 2018
Operating results by business segment        
Net revenue $ 1,788,336 $ 1,810,923 $ 3,527,825 $ 3,616,000
Cost of care (1,001,886) (935,814) (1,943,847) (1,864,475)
Cost of goods sold (461,187) (558,419) (950,980) (1,118,084)
Direct service costs and other (266,434) (259,152) (538,358) (528,229)
Stock compensation expense 5,414 10,439 15,021 18,085
Changes in fair value of contingent consideration (2,149) 70 (2,005) 303
Segment Profit (Loss) 62,094 68,047 107,656 123,600
Managed care and other        
Operating results by business segment        
Net revenue 1,283,143 1,215,340 2,507,122 2,435,103
PBM        
Operating results by business segment        
Net revenue 505,193 595,583 1,020,703 1,180,897
Healthcare        
Operating results by business segment        
Net revenue 1,220,642   2,384,895  
Pharmacy Management        
Operating results by business segment        
Net revenue 612,658   1,229,118  
Operating segments | Healthcare        
Operating results by business segment        
Cost of care (1,001,886) (935,814) (1,943,847) (1,864,475)
Direct service costs and other (177,948) (177,990) (357,138) (364,236)
Stock compensation expense 2,444 2,742 4,194 5,692
Changes in fair value of contingent consideration (2,149) 70 (2,005) 303
Segment Profit (Loss) 41,103 43,896 86,099 89,773
Operating segments | Healthcare | Managed care and other        
Operating results by business segment        
Net revenue 1,220,642 1,154,888 2,384,895 2,312,489
Operating segments | Pharmacy Management        
Operating results by business segment        
Cost of goods sold (505,203) (603,951) (1,035,410) (1,208,864)
Direct service costs and other (78,776) (70,941) (158,411) (146,527)
Stock compensation expense 2,124 1,408 3,796 2,893
Segment Profit (Loss) 30,803 29,913 39,093 45,404
Operating segments | Pharmacy Management | Managed care and other        
Operating results by business segment        
Net revenue 62,648 60,603 122,543 122,910
Operating segments | Pharmacy Management | PBM        
Operating results by business segment        
Net revenue 550,010 642,794 1,106,575 1,274,992
Corporate and Elimination        
Operating results by business segment        
Cost of goods sold 44,016 45,532 84,430 90,780
Direct service costs and other (9,710) (10,221) (22,809) (17,466)
Stock compensation expense 846 6,289 7,031 9,500
Segment Profit (Loss) (9,812) (5,762) (17,536) (11,577)
Corporate and Elimination | Managed care and other        
Operating results by business segment        
Net revenue (147) (151) (316) (296)
Corporate and Elimination | PBM        
Operating results by business segment        
Net revenue $ (44,817) $ (47,211) $ (85,872) $ (94,095)