CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Cash flows from operating activities:
Net income from continuing operations	$ 61,230	$ 56,091	$ 43,634
Net income (loss) from discontinued operations	2,485	(184,706)	(74,952)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	3,357	31,292	49,855
Amortization of deferred loan costs	2,887	2,209	2,520
Amortization of debt discount	8,001	7,564	7,148
Share-based employee compensation expense	6,658	17,538	10,469
Loss on sale of MeYou Health	0	5,325	0
(Gain) loss on sale of TPHS business	(4,733)	192,034	0
Gain on sale of navvis business	0	0	(1,873)
Loss on release of cumulative translation adjustment	3,044	0	0
Equity in (income) loss from joint ventures	0	(271)	20,229
Deferred income taxes	40,935	(75,942)	(5,916)
(Increase) decrease in accounts receivable, net	(3,939)	8,330	16,971
Decrease in other current assets	820	2,819	2,796
(Decrease) increase in accounts payable	(407)	(3,376)	5,248
Decrease in accrued salaries and benefits	(6,061)	(1,056)	(801)
Decrease in other current liabilities	(6,436)	(4,825)	(11,764)
Other	(2,565)	(7,425)	940
Net cash flows provided by operating activities	105,276	45,601	64,504
Cash flows from investing activities:
Acquisition of property and equipment	(5,910)	(14,474)	(34,730)
Investment in joint ventures	0	(1,298)	(5,881)
Proceeds from sale of MeYou Health	0	5,156	0
Proceeds From sale of navvis	0	0	4,369
Payments related to sale of TPHS business	0	(27,469)	0
Other	0	(787)	(1,121)
Net cash flows used in investing activities	(5,910)	(38,872)	(37,363)
Cash flows from financing activities:
Proceeds from issuance of long-term debt	373,450	515,666	572,981
Payments of long-term debt	(449,084)	(527,115)	(597,837)
Payments related to tax withholding for share-based compensation	(4,481)	(7,699)	(3,544)
Exercise of stock options	5,722	10,002	2,467
Repurchase of common stock	0	0	(1,833)
Deferred loan costs	(2,452)	(424)	(892)
Proceeds from non-controlling interest	0	0	1,615
Change in cash overdraft and other	2,533	2,834	1,648
Net cash flows used in financing activities	(74,312)	(6,736)	(25,395)
Effect of exchange rate changes on cash	1,784	(261)	(1,641)
Less: net (decrease) increase in discontinued operations cash and cash equivalents	0	(1,637)	388
Net increase (decrease) in cash and cash equivalents	26,838	1,369	(283)
Cash and cash equivalents, beginning of period	1,602	233	516
Cash and cash equivalents, end of period	28,440	1,602	233
Supplemental disclosure of cash flow information:
Cash paid during the period for interest	4,727	7,474	8,303
Cash paid during the period for income taxes, net of refunds	0	1,458	262
Noncash Activities:
Issuance of CareFirst Warrants	0	192	2,408
Assets acquired through capital lease obligation	0	0	898
Conversion of CareFirst Convertible Note	$ 0	$ 20,000	$ 0