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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Operating Activities:    
Net income (loss) $ 10,028 $ (97,007)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:    
Provision for credit loss 548 123
Loss on right of use assets 0 135
Gain on sale of property and equipment (72) (8)
Depreciation and amortization 22,648 20,254
Amortization-investment discount (1,041) (2,084)
Amortization-debt issuance costs 1,321 978
Equity-based compensation 48,967 54,896
Non-cash lease expense 1,178 1,360
Changes in operating assets and liabilities:    
Accounts receivable (66,451) (19,226)
Prepaid expenses and other current assets (84,326) (8,809)
Other assets (47) 77
Medical expenses payable 239,008 91,726
Accounts payable and accrued expenses 11,180 2,835
Deferred premium revenue 5 (116)
Accrued compensation 8,349 (161)
Lease liabilities (993) (1,492)
Net cash provided by operating activities 190,302 43,481
Investing Activities:    
Purchase of investments (45,194) (75,524)
Sale of property and equipment 75 14
Maturities of investments 57,995 152,755
Sale of business 1,065 0
Acquisition of property and equipment (21,752) (32,134)
Net cash (used in) provided by investing activities (7,811) 45,111
Financing Activities:    
Proceeds from long-term debt 0 50,000
Payment of employment taxes related to release of restricted stock 0 (350)
Debt issuance costs (26) (512)
Proceeds from stock option exercises 2,771 0
Contributions from noncontrolling interest holders 0 15
Net cash provided by financing activities 2,745 49,153
Net increase in cash 185,236 137,745
Cash, cash equivalents and restricted cash at beginning of period 434,942 204,954
Cash, cash equivalents and restricted cash at end of period 620,178 342,699
Supplemental disclosure of cash flow information:    
Cash paid for interest 6,740 15,602
Supplemental non-cash investing and financing activities:    
Acquisition of property in accounts payable 79 112
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:    
Cash and cash equivalents 618,067 340,300
Restricted cash in other assets 2,111 2,399
Total $ 620,178 $ 342,699