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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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The amount of assets reported by an equity method investment of the entity.

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