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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, 2019 | Mar. 31, 2018 | Dec. 31, 2018
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | $ 520,254 |  | $ 459,816
Liabilities | 410,404 |  | 324,211
Equity interests | 109,850 |  | 135,605
Total liabilities and equity | 520,254 |  | $ 459,816
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |
Revenues | 62,817 | $ 43,750 |
Net income | $ 27,135 | $ 19,003 |

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