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Equity method investment - Financial Position and Results of Operations (Details) - Bankers Healthcare Group, LLC - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended |
--- | --- | --- | ---
Sep. 30, 2019 | Sep. 30, 2018 | Sep. 30, 2019 | Sep. 30, 2018 | Dec. 31, 2018
Schedule of Equity Method Investments [Line Items] |  |  |  |  |
Assets | $ 695,300 |  | $ 695,300 |  | $ 459,816
Liabilities | 499,460 |  | 499,460 |  | 324,211
Equity interests | 195,840 |  | 195,840 |  | 135,605
Total liabilities and equity | 695,300 |  | 695,300 |  | $ 459,816
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |  |  |
Revenues | 108,770 | $ 59,133 | 279,569 | $ 151,937 |
Net income | $ 61,364 | $ 30,933 | $ 156,064 | $ 69,039 |

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