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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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