CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net income	$ 18,250	$ 431
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	28,684	30,708
Non-cash interest expense	585	326
Non-cash stock compensation expense	6,057	9,607
Non-cash income tax (benefit) provision	7,802	(250)
Non-cash amortization on investments	325	(192)
Changes in assets and liabilities, net of effects from acquisitions of businesses:
Accounts receivable, net	(33,291)	(23,804)
Pharmaceutical inventory	2,629	(6,333)
Other assets	(41,862)	(10,835)
Accounts payable and accrued liabilities	52,746	20,399
Medical claims payable and other medical liabilities	(13,622)	19,671
Contingent consideration		(1,609)
Tax contingencies	925	83
Deferred credits and other long-term liabilities	3,003	(2,889)
Other	(505)	111
Net cash provided by operating activities	31,726	35,424
Cash flows from investing activities:
Capital expenditures	(15,719)	(12,642)
Acquisitions and investments in businesses, net of cash acquired	(369)	(320)
Purchases of investments	(164,311)	(172,766)
Proceeds from maturities and sales of investments	152,394	128,748
Net cash used in investing activities	(28,005)	(56,980)
Cash flows from financing activities:
Proceeds from borrowings on revolving line of credit	80,000
Payments to acquire treasury stock		(4,124)
Proceeds from exercise of stock options	10,903	2,045
Payments on debt, finance lease and deferred financing obligations	(34,774)	(7,323)
Payments on contingent consideration		(6,247)
Other	(1,136)	(1,702)
Net cash (used in) provided by financing activities	54,993	(17,351)
Net (decrease) increase in cash and cash equivalents	58,714	(38,907)
Cash and cash equivalents at beginning of period	325,249	272,308
Cash and cash equivalents at end of period	383,963	233,401
Non-cash investing activities:
Assets acquired under finance leases and deferred financing obligations	$ 3,599	$ 3,302