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Equity method investment - Financial Position and Results of Operations (Details) - Bankers Healthcare Group, LLC - USD ($) $ in Thousands | 3 Months Ended |
--- | --- | ---
Mar. 31, 2018 | Mar. 31, 2017 | Dec. 31, 2017
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | $ 340,760 |  | $ 330,030
Liabilities | 232,978 |  | 224,837
Membership interests | 107,782 |  | 105,193
Total liabilities and membership interests | 340,760 |  | $ 330,030
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |
Revenues | 43,750 | $ 34,235 |
Net income | $ 19,003 | $ 16,012 |

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