Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

Summary of Significant Accounting Policies

Schedule of disaggregation of revenue by major service line, type of customer and timing of revenue recognition

	Year Ended December 31, 2018
	Healthcare		Pharmacy Management		Elimination		Total
Major Service Lines
Behavioral & Specialty Health
Risk-based, non-EAP	$	1,511,532	$	—	$	(263)	$	1,511,269
EAP risk-based		349,751		—		—		349,751
ASO		249,473		34,130		(344)		283,259
PBM, including dispensing		—		2,183,151		(18,471)		2,164,680
Medicare Part D		—		442,266		—		442,266
PBA		—		132,112		—		132,112
Formulary management		—		70,900		—		70,900
Other		—		3,285		—		3,285
Total net revenue	$	2,110,756	$	2,865,844	$	(19,078)	$	4,957,522
Type of Customer
Government	$	899,515	$	946,606	$	—	$	1,846,121
Non-government		1,211,241		1,919,238		(19,078)		3,111,401
Total net revenue	$	2,110,756	$	2,865,844	$	(19,078)	$	4,957,522
Timing of Revenue Recognition
Transferred at a point in time	$	—	$	2,625,417	$	(18,471)	$	2,606,946
Transferred over time		2,110,756		240,427		(607)		2,350,576
Total net revenue	$	2,110,756	$	2,865,844	$	(19,078)	$	4,957,522

	Year Ended December 31, 2019
	Healthcare		Pharmacy Management		Elimination		Total
Major Service Lines
Behavioral & Specialty Health
Risk-based, non-EAP	$	1,504,472	$	—	$	(290)	$	1,504,182
EAP risk-based		339,377		—		—		339,377
ASO		238,239		40,348		(302)		278,285
PBM, including dispensing		—		1,949,225		(18,151)		1,931,074
Medicare Part D		—		287,604		—		287,604
PBA		—		137,885		—		137,885
Formulary management		—		84,567		—		84,567
Other		—		2,639		—		2,639
Total net revenue	$	2,082,088	$	2,502,268	$	(18,743)	$	4,565,613
Type of Customer
Government	$	916,542	$	831,673	$	—	$	1,748,215
Non-government		1,165,546		1,670,595		(18,743)		2,817,398
Total net revenue	$	2,082,088	$	2,502,268	$	(18,743)	$	4,565,613
Timing of Revenue Recognition
Transferred at a point in time	$	—	$	2,236,829	$	(18,151)	$	2,218,678
Transferred over time		2,082,088		265,439		(592)		2,346,935
Total net revenue	$	2,082,088	$	2,502,268	$	(18,743)	$	4,565,613

	Year Ended December 31, 2020
	Healthcare		Pharmacy Management		Elimination		Total
Major Service Lines
Behavioral & Specialty Health
Risk-based, non-EAP	$	1,399,532	$	—	$	(388)	$	1,399,144
EAP risk-based		315,306		—		—		315,306
ASO		245,031		46,892		(315)		291,608
PBM, including dispensing		—		2,103,702		(19,936)		2,083,766
Medicare Part D		—		243,744		—		243,744
PBA		—		136,155		—		136,155
Formulary management		—		104,891		—		104,891
Other		—		2,917		—		2,917
Total net revenue	$	1,959,869	$	2,638,301	$	(20,639)	$	4,577,531
Type of Customer
Government	$	935,138	$	821,681	$	—	$	1,756,819
Non-government		1,024,731		1,816,620		(20,639)		2,820,712
Total net revenue	$	1,959,869	$	2,638,301	$	(20,639)	$	4,577,531
Timing of Revenue Recognition
Transferred at a point in time	$	—	$	2,347,446	$	(19,936)	$	2,327,510
Transferred over time		1,959,869		290,855		(703)		2,250,021
Total net revenue	$	1,959,869	$	2,638,301	$	(20,639)	$	4,577,531

Schedule of accounts receivable, contract assets and contract liabilities

	December 31,		December 31,
	2019		2020		$ Change		% Change
Accounts receivable	$	717,455	$	799,803	$	82,348		11.5%
Contract assets		2,162		3,566		1,404		64.9%
Contract liabilities - current		6,728		6,772		44		0.7%
Contract liabilities - long-term		11,099		11,073		(26)		(0.2)%

Schedule of customers generating in excess of ten percent of net revenues for respective segment

Segment	Term Date	2018			2019			2020
Healthcare
Customer A	December 31, 2021	$	308,649		$	324,321		$	344,988
Customer B	December 31, 2022		169,508	*		199,036	*		198,199
Pharmacy Management
Customer C	March 31, 2024		344,479			335,682			358,236

* Revenue amount did not exceed 10 percent of net revenues for the respective segment for the year presented. Amount is shown for comparative purposes only.

Schedule of significant restricted assets

	2019		2020
Restricted cash and cash equivalents	$	51,253	$	49,227
Restricted short-term investments		82,772		88,867
Restricted deposits (included in other current assets)		36,215		43,547
Restricted long-term investments		2,307		1,026
Total	$	172,547	$	182,667

Schedule of fair value of financial assets and liabilities

	December 31, 2019
	Level 1		Level 2		Level 3		Total
Assets
Cash and cash equivalents (1)	$	—	$	111,085	$	—	$	111,085
Investments:
U.S. Government and agency securities		30,775		—		—		30,775
Corporate debt securities		—		69,581		—		69,581
Certificates of deposit		—		1,305		—		1,305
Total assets held at fair value	$	30,775	$	181,971	$	—	$	212,746

	December 31, 2020
	Level 1		Level 2		Level 3		Total
Assets
Cash and cash equivalents (2)	$	—	$	679,554	$	—	$	679,554
Investments:
U.S. Government and agency securities		42,399		—		—		42,399
Corporate debt securities		—		99,749		—		99,749
Certificates of deposit		—		1,311		—		1,311
Total assets held at fair value	$	42,399	$	780,614	$	—	$	823,013

(1) Excludes $4.7 million of cash held in bank accounts by the Company.

(2) Excludes $464.9 million of cash held in bank accounts by the Company.

Summary of short-term and long-term investments

	December 31, 2019
			Gross		Gross
	Amortized		Unrealized		Unrealized		Estimated
	Cost		Gains		Losses		Fair Value
U.S. Government and agency securities	$	30,742	$	38	$	(5)	$	30,775
Corporate debt securities		69,552		40		(11)		69,581
Certificates of deposit		1,305		—		—		1,305
Total investments at December 31, 2019	$	101,599	$	78	$	(16)	$	101,661

	December 31, 2020
			Gross		Gross
	Amortized		Unrealized		Unrealized		Estimated
	Cost		Gains		Losses		Fair Value
U.S. Government and agency securities	$	42,389	$	11	$	(1)	$	42,399
Corporate debt securities		99,861		3		(115)		99,749
Certificates of deposit		1,311		—		—		1,311
Total investments at December 31, 2020	$	143,561	$	14	$	(116)	$	143,459

Summary of maturity dates of investments

	December 31, 2020
			Gross		Gross
	Amortized		Unrealized		Unrealized		Estimated
	Cost		Gains		Losses		Fair Value
U.S. Government and agency securities	$	42,389	$	11	$	(1)	$	42,399
Corporate debt securities		99,861		3		(115)		99,749
Certificates of deposit		1,311		—		—		1,311
Total investments at December 31, 2020	$	143,561	$	14	$	(116)	$	143,459

Schedule of net property and equipment

	2019		2020
Building improvements	$	17,726	$	12,027
Equipment		188,611		188,954
Finance leases - property		26,945		10,455
Finance leases - equipment		26,856		32,568
Capitalized internal-use software		570,989		626,186
		831,127		870,190
Accumulated depreciation		(699,415)		(733,451)
Property and equipment, net	$	131,712	$	136,739

Schedule of goodwill

	2019		2020
Behavioral & Specialty Health	$	410,869	$	478,227
Pharmacy Management		395,552		395,552
Total	$	806,421	$	873,779

	2019		2020
Balance as of beginning of period	$	806,421	$	806,421
Acquisition of Bayless		—		67,358
Balance as of end of period	$	806,421	$	873,779

Schedule of intangible assets

The following is a summary of intangible assets at December 31, 2019 and 2020, and the estimated useful lives for such assets (in thousands, except useful lives):

	December 31, 2019
					Weighted Avg		Gross				Net
	Original				Remaining		Carrying		Accumulated		Carrying
Asset	Useful Life				Useful Life		Amount		Amortization		Amount
Customer agreements and lists	2.5	to	18	years	3.3	years	$	347,033	$	(267,977)	$	79,056
Provider networks and other	1	to	16	years	2.3	years		20,760		(18,141)		2,619
							$	367,793	$	(286,118)	$	81,675

	December 31, 2020
					Weighted Avg		Gross				Net
	Original				Remaining		Carrying		Accumulated		Carrying
Asset	Useful Life				Useful Life		Amount		Amortization		Amount
Customer agreements and lists	2.5	to	18	years	4.7	years	$	380,853	$	(306,173)	$	74,680
Provider networks and other	1	to	16	years	2.8	years		24,151		(20,692)		3,459
Trade names and licenses	indefinite				indefinite			1,550		—		1,550
							$	406,554	$	(326,865)	$	79,689

Schedule of changes in medical claims payable

	2018		2019		2020
Claims payable and IBNR, beginning of period	$	126,861	$	126,311	$	123,276
Cost of care:
Current year		1,555,491		1,545,024		1,403,555
Prior years(3)		(800)		(1,500)		(5,700)
Total cost of care		1,554,691		1,543,524		1,397,855
Claim payments and transfers to other medical liabilities(1):
Current year		1,441,621		1,433,214		1,306,519
Prior years		113,620		113,345		107,241
Total claim payments and transfers to other medical liabilities		1,555,241		1,546,559		1,413,760
Claims payable and IBNR, end of period		126,311		123,276		107,371
Withhold payable, end of period(2)		3,418		4,838		4,480
Medical claims payable, end of period	$	129,729	$	128,114	$	111,851

(1) For any given period, a portion of unpaid medical claims payable could be covered by risk share or reinvestment liabilities (discussed below) and may not impact the Company’s results of operations for such periods.

(2) Medical claims payable is offset by customer withholds from capitation payments in situations in which the customer has the contractual requirement to pay providers for care incurred.

(3) Favorable development in 2018, 2019 and 2020 was $0.8 million, $1.5 million and $5.7 million, respectively, and was mainly related to lower medical trends and faster claims completion than originally assumed.

Schedule of leases

	Year Ended December 31, 2020
Operating lease cost	$	9,506
Finance lease cost:
Amortization of right-of-use asset		3,419
Interest on lease liabilities		785
Total finance lease cost		4,204
Short-term lease cost		298
Variable lease cost		2,656
Total lease cost		16,664
Sublease income		(258)
Net lease cost	$	16,406

	December 31, 2020
Operating leases:
Other long-term assets	$	23,545
Accrued liabilities	$	14,526
Deferred credits and other long-term liabilities		24,923
Total operating lease liabilities	$	39,449
Finance leases:
Property and equipment, net	$	11,892
Current debt, finance lease and deferred financing obligations	$	4,460
Long-term debt, finance lease and deferred financing obligations		11,967
Total finance lease liabilities	$	16,427

	December 31, 2020
Weighted average remaining lease term
Operating leases		3.94
Finance leases		3.96
Weighted average discount rate
Operating leases		4.79%
Finance leases		4.39%

	Year ended December 31, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	12,268
Operating cash flows from finance leases		5,401
Financing cash flows from finance leases		785
Right-of-use asset obtained in exchange for new lease obligation
Operating leases		1,677
Finance leases		3,599

Schedule of maturity dates of leases

	December 31, 2020
2020	$	19,535
2021		14,883
2022		10,349
2023		8,557
2024		3,228
2025 and beyond		673
Total lease payments		57,225
Less interest		(1,349)
Present value of lease liabilities	$	55,876