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Schedule of intangible assets (Detail) - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 144,476,000 | $ 132,727,000 |
Finite-lived Intangible Assets, Additions | 0 | 14,984,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | (3,235,000) |
Intangible Assets, Gross, Total, Ending Balance | 144,476,000 | 144,476,000 | $ 132,727,000
Accumulated Amortization | (57,600,117) | (40,942,442) |
Intangible Assets, Net | 86,875,883 | 103,533,558 |
Medicare License | Indefinite-lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | 1,994,000 | 0 |
Finite-lived Intangible Assets, Additions | 0 | 1,994,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | 0 |
Intangible Assets, Gross, Total, Ending Balance | 1,994,000 | 1,994,000 | 0
Accumulated Amortization | 0 | 0 |
Intangible Assets, Net | $ 1,994,000 | $ 1,994,000 |
Network relationships | Maximum [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 15 years | 15 years |
Network relationships | Minimum [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 11 years | 11 years |
Network relationships | Finite-Lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 109,883,000 | $ 106,660,000 |
Finite-lived Intangible Assets, Additions | 0 | 3,223,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | 0 |
Intangible Assets, Gross, Total, Ending Balance | 109,883,000 | 109,883,000 | 106,660,000
Accumulated Amortization | (48,361,773) | (35,842,508) |
Intangible Assets, Net | $ 61,521,227 | $ 74,040,492 |
Trade name |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 20 years | 20 years |
Trade name | Finite-Lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 1,011,000 | $ 0 |
Finite-lived Intangible Assets, Additions | 0 | 1,011,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | 0 |
Intangible Assets, Gross, Total, Ending Balance | 1,011,000 | 1,011,000 | 0
Accumulated Amortization | (54,763) | (4,212) |
Intangible Assets, Net | $ 956,237 | $ 1,006,788 |
Management contracts [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 15 years | 15 years |
Management contracts [Member] | Finite-Lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 22,832,000 | $ 22,832,000 |
Finite-lived Intangible Assets, Additions | 0 | 0 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | 0 |
Intangible Assets, Gross, Total, Ending Balance | 22,832,000 | 22,832,000 | 22,832,000
Accumulated Amortization | (7,447,581) | (5,014,886) |
Intangible Assets, Net | $ 15,384,419 | $ 17,817,114 |
Member relationships [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 12 years |  |
Member relationships [Member] | Maximum [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) |  | 12 years |
Member relationships [Member] | Minimum [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) |  | 5 years |
Member relationships [Member] | Finite-Lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 6,696,000 | $ 3,235,000 |
Finite-lived Intangible Assets, Additions | 0 | 6,696,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | (3,235,000) |
Intangible Assets, Gross, Total, Ending Balance | 6,696,000 | 6,696,000 | $ 3,235,000
Accumulated Amortization | (1,289,667) | (46,500) |
Intangible Assets, Net | $ 5,406,333 | 6,649,500 |
Patient management platform [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Weighted Average Life (Yrs) | 5 years |  | 5 years
Patient management platform [Member] | Finite-Lived Intangible Assets [Member] |  |  |
Finite-Lived Intangible Assets [Line Items] |  |  |
Intangible Assets, Gross, Total, Beginning Balance | $ 2,060,000 | 0 |
Finite-lived Intangible Assets, Additions | 0 | 2,060,000 |
Finite-lived Intangible Assets, Impairment/Disposal | 0 | 0 |
Intangible Assets, Gross, Total, Ending Balance | 2,060,000 | 2,060,000 | $ 0
Accumulated Amortization | (446,333) | (34,336) |
Intangible Assets, Net | $ 1,613,667 | $ 2,025,664 |

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