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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash Flows Provided by (Used In) Operating Activities      
Net loss $ (37,601,000) $ (334,246,000) $ (305,580,000)
Adjustments to reconcile net loss to net cash and restricted cash used in operating activities:      
Change in fair value of contingent consideration and indemnification asset 13,281,000 3,860,000 (3,997,000)
(Gain) loss on disposal of assets 6,786,000 698,000 (9,600,000)
(Gain) loss from equity method investees (13,179,000) (10,039,000) 9,465,000
Depreciation and amortization expenses 60,037,000 61,475,000 60,913,000
Impairment of equity method investments 0 47,133,000 0
Stock-based compensation expense 16,711,000 14,606,000 15,618,000
Deferred tax benefit (526,000) (1,132,000) (23,124,000)
Amortization of contract cost assets 13,041,000 21,195,000 5,723,000
Amortization of deferred financing costs 18,045,000 14,780,000 9,370,000
Interest from customer advance for regulatory capital requirements (323,000) (1,869,000) (1,300,000)
Gain on transfer of membership (45,938,000) 0 0
Goodwill impairment 0 215,100,000 199,800,000
Loss on repayment of debt 21,343,000 0 0
Loss on repayment of debt 0 4,789,000 0
Other current operating cash inflows (outflows), net 715,000 2,744,000 (264,000)
Changes in assets and liabilities, net of acquisitions:      
Accounts receivable, net and contract assets (5,779,000) (47,017,000) 6,326,000
Prepaid expenses and other current and non-current assets 5,599,000 7,340,000 791,000
Contract cost assets (18,979,000) (11,400,000) (23,057,000)
Accounts payable 7,250,000 3,547,000 (5,480,000)
Accrued liabilities (324,000) 8,801,000 (21,852,000)
Accrued compensation and employee benefits 3,538,000 11,143,000 9,246,000
Deferred revenue (739,000) (8,943,000) (756,000)
Reserve for claims and performance-based arrangements (3,799,000) (36,108,000) 33,555,000
Right-of-use operating assets 8,844,000 11,934,000 (20,811,000)
Operating lease liabilities (6,522,000) (2,782,000) 27,724,000
Other long-term liabilities (2,734,000) 8,166,000 (5,355,000)
Net cash and restricted cash provided by (used in) operating activities 38,747,000 (16,225,000) (42,645,000)
Cash Flows Provided by (Used In) Investing Activities      
Cash paid for asset acquisitions and business combinations (49,012,000) (300,000) (8,575,000)
Proceeds from transfer of membership and release of Passport escrow 42,996,000 0 0
Loan for implementation funding 0 1,000,000 5,400,000
Disposal of non-strategic assets and divestiture of discontinued operations, net 3,490,000 (2,287,000) 0
Return of equity method investments 14,218,000 0 0
Customer advance for regulatory capital requirements 0 0 (46,400,000)
Investments in equity method investees 0 0 (87,480,000)
Impact to cash and cash equivalents and restricted cash from initial consolidation 0 159,755,000 0
Purchases of investments (2,995,000) (11,170,000) (11,125,000)
Maturities and sales of investments 500,000 143,441,000 2,575,000
Investments in internal-use software and purchases of property and equipment (24,983,000) (29,473,000) (35,534,000)
Other investing activities 0 106,000 (495,000)
Net cash and restricted cash (used in) provided by investing activities (15,786,000) 261,072,000 (181,634,000)
Cash Flows Used In Financing Activities      
Changes in working capital balances related to claims processing on behalf of partners 61,162,000 (6,044,000) (104,268,000)
Amount received from escrow in asset acquisition 0 0 500,000
Repayment and termination of Credit Agreement including settlement of warrants (98,420,000) 0 0
Proceeds from issuance of long term debt, net of offering costs 0 30,062,000 62,648,000
Issuance of warrant liability 0 0 7,092,000
Repayment and repurchase of 2021 Notes and financing fees (429,000) (16,606,000) 0
Proceeds from stock option exercises 13,289,000 2,577,000 1,092,000
Distributions to Sponsors (1,300,000) (20,000,000) 0
Taxes withheld and paid for vesting of restricted stock units (3,850,000) (1,851,000) (2,609,000)
Net cash and restricted cash used in financing activities (29,548,000) (11,862,000) (35,545,000)
Effect of exchange rate on cash and cash equivalents and restricted cash (52,000) 65,000 30,000
Net increase (decrease) in cash and cash equivalents and restricted cash (6,639,000) 233,050,000 (259,794,000)
Cash and cash equivalents and restricted cash as of beginning-of-period [1] 361,581,000 128,531,000 388,325,000
Cash and cash equivalents and restricted cash as of end-of-period [1] $ 354,942,000 $ 361,581,000 $ 128,531,000
[1] See Note 5.