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Equity method investment - Financial Position and Results of Operations (Details) - Bankers Healthcare Group, LLC - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended |
--- | --- | --- | ---
Jun. 30, 2019 | Jun. 30, 2018 | Jun. 30, 2019 | Jun. 30, 2018 | Dec. 31, 2018
Schedule of Equity Method Investments [Line Items] |  |  |  |  |
Assets | $ 606,548 |  | $ 606,548 |  | $ 459,816
Liabilities | 451,095 |  | 451,095 |  | 324,211
Equity interests | 155,453 |  | 155,453 |  | 135,605
Total liabilities and equity | 606,548 |  | 606,548 |  | $ 459,816
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |  |  |
Revenues | 107,982 | $ 49,053 | 170,799 | $ 92,804 |
Net income | $ 67,564 | $ 19,102 | $ 94,699 | $ 38,106 |

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