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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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