0001564590-19-026364 | 10-Q | XBRL Viewer

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Document and Entity Information - shares	6 Months Ended
Document and Entity Information - shares	Jun. 30, 2019	Jul. 24, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Trading Symbol	HSTM
Entity Registrant Name	HEALTHSTREAM INC
Entity Central Index Key	0001095565
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		32,373,525
Entity Shell Company	false
Entity File Number	000-27701
Entity Tax Identification Number	621443555
Entity Address, Address Line One	500 11th Avenue North
Entity Address, Address Line Two	Suite 1000
Entity Address, City or Town	Nashville
Entity Address, State or Province	Tennessee
Entity Address, Postal Zip Code	37203
City Area Code	(615)
Local Phone Number	301‑3100

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 120,849	$ 134,321
Marketable securities	40,737	34,497
Accounts receivable, net of allowance for doubtful accounts of $843 and $1,161 at June 30, 2019 and December 31, 2018, respectively	27,800	38,124
Accounts receivable - unbilled	2,036	2,880
Prepaid royalties, net of amortization	11,970	13,596
Other prepaid expenses and other current assets	11,089	18,016
Total current assets	214,481	241,434
Property and equipment, net of accumulated depreciation of $16,754 and $20,827 at June 30, 2019 and December 31, 2018, respectively	28,544	15,866
Capitalized software development, net of accumulated amortization of $52,084 and $46,757 at June 30, 2019 and December 31, 2018, respectively	20,764	18,352
Operating lease right of use assets, net	30,774
Goodwill	97,300	86,144
Deferred tax assets	251	145
Deferred commissions	15,534	16,470
Non-marketable equity investments	6,786	3,376
Other assets	1,224	783
Total assets	476,451	441,948
Current liabilities:
Accounts payable and accrued expenses	18,121	25,037
Accrued royalties	13,462	15,756
Deferred revenue	66,730	66,061
Total current liabilities	98,313	106,854
Deferred tax liabilities	13,136	11,068
Deferred revenue, noncurrent	2,669	2,868
Operating lease liability, noncurrent	32,046
Other long term liabilities	616	2,211
Commitments and contingencies
Shareholders’ equity:
Common stock, no par value, 75,000 shares authorized; 32,374 and 32,325 shares issued and outstanding at June 30, 2019 and December 31, 2018, respectively	288,900	286,597
Retained earnings	40,748	32,373
Accumulated other comprehensive income (loss)	23	(23)
Total shareholders’ equity	329,671	318,947
Total liabilities and shareholders’ equity	476,451	441,948
Customer-Related Intangible Assets [Member]
Current assets:
Intangible assets, net	53,437	53,469
Other Intangible Assets [Member]
Current assets:
Intangible assets, net	$ 7,356	$ 5,909

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Allowance for doubtful accounts, net	$ 843	$ 1,161
Accumulated depreciation on property and equipment	16,754	20,827
Accumulated amortization on capitalized software development	$ 52,084	$ 46,757
Common stock, no par value
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	32,374,000	32,325,000
Common stock, shares outstanding	32,374,000	32,325,000
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 26,478	$ 23,245
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 11,266	$ 9,663

Condensed Consolidated Statements of Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Statement [Abstract]
Revenues, net	$ 63,781	$ 57,008	$ 128,967	$ 111,866
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	26,806	23,236	53,667	45,484
Product development	7,640	6,547	14,567	12,548
Sales and marketing	9,819	8,913	19,340	17,977
Other general and administrative expenses	10,306	8,029	20,276	15,772
Depreciation and amortization	6,942	6,019	13,480	12,091
Total operating costs and expenses	61,513	52,744	121,330	103,872
Operating income	2,268	4,264	7,637	7,994
Other income, net	852	476	1,674	789
Income from continuing operations before income tax provision	3,120	4,740	9,311	8,783
Income tax provision	719	1,084	2,130	1,498
Income from continuing operations	2,401	3,656	7,181	7,285
Loss from discontinued operations before income tax provision				(64)
(Loss) Gain on sale of discontinued operations		(1,502)	1,620	29,490
Income tax (benefit) provision		(391)	426	10,319
(Loss) Income from discontinued operations		(1,111)	1,194	19,107
Net income	$ 2,401	$ 2,545	$ 8,375	$ 26,392
Net income (loss) per share – basic:
Continuing operations	$ 0.07	$ 0.11	$ 0.22	$ 0.23
Discontinued operations		(0.03)	0.04	0.59
Net income per share - basic	0.07	0.08	0.26	0.82
Net income (loss) per share - diluted:
Continuing operations	0.07	0.11	0.22	0.23
Discontinued operations		(0.03)	0.04	0.59
Net income per share - diluted	$ 0.07	$ 0.08	$ 0.26	$ 0.82
Weighted average shares of common stock outstanding:
Basic	32,394	32,312	32,366	32,205
Diluted	32,434	32,378	32,406	32,255
Dividends declared per share				$ 1.00

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 2,401	$ 2,545	$ 8,375	$ 26,392
Other comprehensive income, net of taxes:
Unrealized gain (loss) on marketable securities	14	(10)	46	5
Total other comprehensive income (loss)	14	(10)	46	5
Comprehensive income	$ 2,415	$ 2,535	$ 8,421	$ 26,397

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Condensed Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Retained Earnings (Accumulated Deficit) [Member]	Accumulated Other Comprehensive (Loss) Income [Member]
Beginning balance at Dec. 31, 2017	$ 300,170	$ 282,666	$ 17,542	$ (38)
Beginning balance, shares at Dec. 31, 2017		31,908
Cumulative effect of accounting change	15,132		15,132
Net income	23,846		23,846
Comprehensive income (loss)	15			15
Dividends declared on common stock ($1.00 per share)	(32,518)		(32,518)
Stock based compensation	328	$ 328
Common stock issued under stock plans, net of shares withheld for employee taxes	2,071	$ 2,071
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		394
Ending balance at Mar. 31, 2018	309,044	$ 285,065	24,002	(23)
Ending balance, shares at Mar. 31, 2018		32,302
Beginning balance at Dec. 31, 2017	300,170	$ 282,666	17,542	(38)
Beginning balance, shares at Dec. 31, 2017		31,908
Net income	26,392
Comprehensive income (loss)	5
Ending balance at Jun. 30, 2018	312,187	$ 285,673	26,547	(33)
Ending balance, shares at Jun. 30, 2018		32,317
Beginning balance at Mar. 31, 2018	309,044	$ 285,065	24,002	(23)
Beginning balance, shares at Mar. 31, 2018		32,302
Net income	2,545		2,545
Comprehensive income (loss)	(10)			(10)
Stock based compensation	427	$ 427
Common stock issued under stock plans, net of shares withheld for employee taxes	181	$ 181
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		15
Ending balance at Jun. 30, 2018	312,187	$ 285,673	26,547	(33)
Ending balance, shares at Jun. 30, 2018		32,317
Beginning balance at Dec. 31, 2018	$ 318,947	$ 286,597	32,373	(23)
Beginning balance, shares at Dec. 31, 2018	32,325	32,325
Net income	$ 5,974		5,974
Comprehensive income (loss)	32			32
Stock based compensation	516	$ 516
Common stock issued under stock plans, net of shares withheld for employee taxes	(328)	$ (328)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		63
Ending balance at Mar. 31, 2019	325,141	$ 286,785	38,347	9
Ending balance, shares at Mar. 31, 2019		32,388
Beginning balance at Dec. 31, 2018	$ 318,947	$ 286,597	32,373	(23)
Beginning balance, shares at Dec. 31, 2018	32,325	32,325
Net income	$ 8,375
Comprehensive income (loss)	46
Ending balance at Jun. 30, 2019	$ 329,671	$ 288,900	40,748	23
Ending balance, shares at Jun. 30, 2019	32,374	32,374
Beginning balance at Mar. 31, 2019	$ 325,141	$ 286,785	38,347	9
Beginning balance, shares at Mar. 31, 2019		32,388
Net income	2,401		2,401
Comprehensive income (loss)	14			14
Stock donated to Company (held in treasury)		(86)
Stock based compensation	2,558	$ 2,558
Common stock issued under stock plans, net of shares withheld for employee taxes	(443)	$ (443)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		72
Ending balance at Jun. 30, 2019	$ 329,671	$ 288,900	$ 40,748	$ 23
Ending balance, shares at Jun. 30, 2019	32,374	32,374

Condensed Consolidated Statements of Shareholders' Equity (Unaudited) (Parenthetical) - $ / shares	3 Months Ended	6 Months Ended
	Mar. 31, 2018	Jun. 30, 2018
Statement Of Stockholders Equity [Abstract]
Dividends per share common stock	$ 1.00	$ 1.00

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
OPERATING ACTIVITIES:
Net income	$ 8,375	$ 26,392
Income from discontinued operations	(1,194)	(19,107)
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	13,480	12,091
Stock based compensation	3,074	846
Amortization of deferred commissions	4,201	3,735
Provision for doubtful accounts	48	390
Deferred income taxes	2,066	636
Gain on non-marketable equity investments	(69)	(5)
Other	(84)
Changes in operating assets and liabilities:
Accounts and unbilled receivables	12,019	3,905
Prepaid royalties	1,626	1,361
Other prepaid expenses and other current assets	2,746	(6,532)
Deferred commissions	(3,265)	(4,146)
Other assets	(391)	3,747
Accounts payable and accrued expenses	(4,060)	(8,087)
Accrued royalties	(2,294)	(2,298)
Deferred revenue	329	3,277
Net cash provided by continuing operating activities	36,607	16,205
Net cash used in discontinued operating activities		(1,003)
Net cash provided by operating activities	36,607	15,202
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(18,018)
Proceeds from sale of discontinued operations	6,222	57,828
Proceeds from maturities of marketable securities	38,037	44,663
Purchases of marketable securities	(44,158)	(41,266)
Proceeds from sale of property and equipment	12
Payments to acquire cost method investments	(3,342)
Payments associated with capitalized software development	(8,374)	(5,094)
Purchases of property and equipment	(19,598)	(3,270)
Net cash (used in) provided by continuing investing activities	(49,219)	52,861
Net cash used in discontinued investing activities		(116)
Net cash (used in) provided by investing activities	(49,219)	52,745
FINANCING ACTIVITIES:
Proceeds from exercise of stock options	214	2,552
Taxes paid related to net settlement of equity awards	(985)	(300)
Payments of earn-outs related to acquisitions	(37)	(37)
Payment of cash dividends	(52)	(32,353)
Net cash used in continuing financing activities	(860)	(30,138)
Net cash used in financing activities	(860)	(30,138)
Net (decrease) increase in cash and cash equivalents	(13,472)	37,809
Cash and cash equivalents at beginning of period	134,321	84,768
Cash and cash equivalents at end of period	$ 120,849	$ 122,577

Basis of Presentation

6 Months Ended

Jun. 30, 2019

Accounting Policies [Abstract]

Basis of Presentation

1. BASIS OF PRESENTATION

The accompanying Condensed Consolidated Financial Statements (unaudited) have been prepared in accordance with accounting principles generally accepted in the United States (“US GAAP”) for interim financial information and with the instructions to Form 10‑Q and Article 10 of Regulation S‑X. Accordingly, Condensed Consolidated Financial Statements do not include all of the information and footnotes required by US GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation have been included. All intercompany transactions have been eliminated in consolidation. Operating results for the three and six months ended June 30, 2019 are not necessarily indicative of the results that may be expected for the year ending December 31, 2019.

On February 12, 2018, the Company divested its Patient Experience (“PX”) business to Press Ganey Associates, Inc. (“Press Ganey”). The sale of the PX business resulted in the Company’s divestiture of the Company’s patient experience solutions business segment. The Company has classified the results of its previously owned PX segment as discontinued operations in its Condensed Consolidated Statements of Income and Cash Flows for all periods presented. See Note 8 for additional information.

The Condensed Consolidated Balance Sheet at December 31, 2018 has been derived from the audited Consolidated Financial Statements at that date and has been adjusted to reflect the Company’s discontinued operations as noted above but does not include all of the information and footnotes required by US GAAP for complete financial statements. For further information, refer to the Consolidated Financial Statements and footnotes thereto for the year ended December 31, 2018 (included in the Company's Annual Report on Form 10-K, filed with the Securities and Exchange Commission on February 25, 2019).

Recent Accounting Pronouncements

6 Months Ended

Jun. 30, 2019

Accounting Changes And Error Corrections [Abstract]

Recent Accounting Pronouncements

2. RECENT ACCOUNTING PRONOUNCEMENTS

Accounting Standards Recently Adopted

In February 2016, the FASB issued ASU 2016-02, Leases (“ASC 842”), which, among other things, requires an entity to recognize a right-of-use asset and a lease liability on the balance sheet for substantially all leases, including operating leases. The Company adopted ASC 842 effective January 1, 2019 utilizing the modified retrospective approach such that prior year Financial Statements were not recast under the new standard. Adoption of this standard resulted in changes to the Company’s Condensed Consolidated Balance Sheets and accounting policies for leases but did not have an impact on the Condensed Consolidated Statements of Income or Cash Flows. See Note 12 for additional information regarding the new standard and its impact on the Company’s Financial Statements.

Accounting Standards Not Yet Adopted

In June 2016, the FASB issued ASU 2016-03, Financial Instruments—Credit Losses (“ASC 326”): Measurement of Credit Losses on Financial Instruments, which amends guidance on reporting credit losses for assets held at amortized cost basis and available for sale debt securities. For assets held at amortized cost basis, ASC 326 eliminates the probable initial recognition threshold in current GAAP and, instead, requires an entity to reflect its current estimate of all expected credit losses. The standard will be effective for the first interim period within annual reporting periods beginning after December 15, 2019. The Company will adopt this ASU on January 1, 2020 and is currently evaluating the impact that adoption of this ASU will have on the Company’s consolidated financial position and results of operations.

Revenue Recognition And Sales Commissions

6 Months Ended

Jun. 30, 2019

Revenue From Contract With Customer [Abstract]

Revenue Recognition And Sales Commissions

3. REVENUE RECOGNITION AND SALES COMMISSIONS

Revenue Recognition

Revenues are recognized when control of the promised goods or services is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled to in exchange for transferring those goods or services.

Revenue is recognized based on the following five step model:

•

Identification of the contract with a customer

•

Identification of the performance obligations in the contract

•

Determination of the transaction price

•

Allocation of the transaction price to the performance obligations in the contract

•

Recognition of revenue when, or as, the Company satisfies a performance obligation

The following table represents our revenues included in continuing operations from contracts with customers disaggregated by revenue source for the three and six months ended June 30, 2019 and 2018 (in thousands). Sales taxes are excluded from revenues.

	Three Months Ended June 30, 2019						Six Months Ended June 30, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated		Workforce Solutions		Provider Solutions		Consolidated
Subscription/SaaS services	$	50,892	$	9,501	$	60,393	$	103,696	$	18,581	$	122,277
Professional services		1,530		1,858		3,388		3,020		3,670		6,690
Total revenues, net	$	52,422	$	11,359	$	63,781	$	106,716	$	22,251	$	128,967

	Three Months Ended June 30, 2018						Six Months Ended June 30, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated		Workforce Solutions		Provider Solutions		Consolidated
Subscription/SaaS services	$	45,743	$	8,667	$	54,410	$	89,444	$	17,700	$	107,144
Professional services		1,225		1,373		2,598		2,471		2,251		4,722
Total revenues, net	$	46,968	$	10,040	$	57,008	$	91,915	$	19,951	$	111,866

Subscription/SaaS services revenues primarily consist of fees in consideration of providing customers access to one or more of our SaaS-based solutions and/or courseware subscriptions, as well as fees related to licensing agreements, all of which include routine customer support and technology enhancements. Revenue is generally recognized over time during the contract term beginning when the service is made available to the customer. Subscription/SaaS contracts are generally non-cancelable, one to five years in length, and billed annually, semi-annually, quarterly, or monthly in advance.

Professional services revenues primarily consist of fees for implementation services, custom courseware development, and training. The majority of our professional services contracts are billed in advance based on a fixed price basis, and revenue is recognized over time as the services are performed. For both subscription/SaaS services and professional services, the time between billing the customer and when performance obligations are satisfied is not significant.

Our contracts with customers often contain multiple performance obligations. For these contracts, the Company accounts for individual performance obligations separately if they are distinct. The contract price, which represents transaction price, is allocated to the separate performance obligations on a relative standalone selling price basis. We generally determine standalone selling prices based on the standard list price for each product, taking into consideration certain factors, including contract length and the number of subscriptions within the contract.

We receive payments from customers based on billing schedules established in our contracts. Accounts receivable - unbilled represent contract assets related to our conditional right to consideration for subscription/SaaS and professional services contracts where performance has occurred under the contract. Accounts receivable are primarily comprised of trade receivables that are recorded at the invoice amount, net of an allowance for doubtful accounts, when the right to consideration becomes unconditional.

For the three months ended June 30, 2019, the Company recognized $46,000 in impairment losses on receivables and contract assets arising from the Company’s contracts with customers. For the three months ended June 30, 2018 the Company did not recognize any impairment losses on receivables and contract assets arising from the Company’s contracts with customers. For the six months ended June 30, 2019 and 2018, the Company recognized $48,000 and $390,000 in impairment losses on receivables and contract assets arising from the Company’s contracts with customers.

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations. During the three months ended June 30, 2019 and 2018, we recognized $36.3 million and $33.8 million of revenue from amounts included in deferred revenues at the beginning of the respective period, respectively. During the six months ended June 30, 2019 and 2018, we recognized $51.2 million and $48.0 million of revenue from amounts included in deferred revenues at the beginning of the respective periods. As of June 30, 2019, $436 million of revenue is expected to be recognized from remaining performance obligations under contract with customers. We expect to recognize revenue with respect to 47% of these remaining performance obligations over the next 12 months, with the remaining amounts recognized thereafter.

Sales Commissions

Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer. The Company’s sales commission plans for 2018 and 2019 typically include multiple payments, including initial payments in the period a customer contract is obtained and subsequent payments either 15 or 27 months after the initial payment. Under ASC 606, costs to acquire contracts with customers, such as the initial sales commission payment, are capitalized in the period a customer contract is obtained and are amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit, whereas subsequent sales commission payments which require a substantive performance condition of the employee are expensed ratably through the payment date. The capitalized contract cost is included in deferred commissions in the accompanying Condensed Consolidated Balance Sheets. The expected period of benefit is the contract term, except when the capitalized commission is expected to provide economic benefit to the Company for a period longer than the contract term, such as for new customer or incremental sales where renewals are expected and renewal commissions are not commensurate with initial commissions. Non-commensurate commissions are amortized over the greater of the expected period of benefit or technological obsolescence period. The Company recorded amortization of deferred commissions of $2.1 million and $1.9 million for the three months ended June 30, 2019 and 2018, respectively, and $4.2 million and $3.7 million for the six months ended June 30, 2019 and 2018, respectively, which is included in Sales and marketing expenses in the accompanying Condensed Consolidated Statements of Income.

Income Taxes

6 Months Ended

Jun. 30, 2019

Income Tax Disclosure [Abstract]

Income Taxes

4. INCOME TAXES

Income taxes are accounted for using the asset and liability method, whereby deferred tax assets and liabilities are determined based on the temporary differences between the financial statement and tax bases of assets and liabilities measured at tax rates that will be in effect for the year in which the differences are expected to affect taxable income.

During the three months ended June 30, 2019 and 2018, the Company recorded a provision for income taxes from continuing operations of $719,000 and $1.1 million, respectively. During the six months ended June 30, 2019 and 2018, the Company recorded a provision for income taxes from continuing operations of $2.1 million and $1.5 million, respectively. The Company’s effective tax rate for continuing operations for the six months ended June 30, 2019 and 2018 was 23% and 17%, respectively. The Company’s effective tax rate primarily reflects the statutory corporate income tax rate, the net effect of state taxes, and the effect of various permanent tax differences. Additionally, during the six months ended June 30, 2019 and 2018, the Company recorded excess tax benefits related to stock based awards of $123,000 and $663,000, respectively, as a component of the provision for income taxes.

Shareholders' Equity

6 Months Ended

Jun. 30, 2019

Equity [Abstract]

Shareholders' Equity

5. SHAREHOLDERS’ EQUITY

Dividends on Common Stock

On February 12, 2018, the Company’s Board of Directors declared a $1.00 per common share special cash dividend, which was paid on April 3, 2018 to shareholders of record on March 6, 2018.

Stock Based Compensation

The Company has stock awards outstanding under two stock incentive plans: the Company’s 2016 Omnibus Incentive Plan and 2010 Stock Incentive Plan. The Company accounts for its stock based compensation plans using the fair-value based method for costs related to stock based payments, including stock options and restricted share units (“RSUs”). During the six months ended June 30, 2019, the Company issued 86,220 RSUs, subject to service-based time vesting, with a weighted average grant date fair value of $27.39 per share, measured based on the closing fair market value of the Company’s stock on the date of grant. During the six months ended June 30, 2018, the Company issued 83,168 RSUs, subject to service-based time vesting, with a weighted average grant date fair value of $24.70 per share, measured based on the closing fair market value of the Company’s stock on the date of grant.

Total stock based compensation expense recorded for the three and six months ended June 30, 2019 and 2018, which is recorded within continuing operations in the Condensed Consolidated Statements of Income, is as follows (in thousands):

	Three Months Ended June 30,				Six Months Ended June 30,
	2019		2018		2019		2018
Cost of revenues (excluding depreciation and amortization)	$	670	$	10	$	671	$	18
Product development		765		72		818		145
Sales and marketing		462		50		518		82
Other general and administrative		661		295		1,067		601
Total stock based compensation expense	$	2,558	$	427	$	3,074	$	846

Stock Awards

During June 2019, the Company’s Chief Executive Officer, Robert A. Frist, Jr., contributed 78,520 of his personally owned shares of HealthStream, Inc. common stock (valued at $2.0 million) to the Company, without any consideration paid to him, for the benefit of the Company’s employees. In connection therewith, effective June 26, 2019 the Company approved the award of 78,520 fully vested shares of common stock to approximately 820 employees of the Company under the HealthStream, Inc. 2016 Omnibus Incentive Plan. These shares were issued in July 2019. As required by ASC Topic 718, Compensation – Stock Compensation, the Company recognized $2.0 million of stock based compensation expense for these stock awards during the three months ended June 30, 2019 based on the closing fair market value of the Company’s stock on the date of the Company’s approval of these grants. Total payments related to the employees’ tax obligations to taxing authorities for these stock awards were $627,000 and are reflected as a financing activity within the Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2019. In addition, the employer taxes and expenses associated with these grants were $0.2 million and were recorded as an expense during June 2019. Mr. Frist contributed an additional 7,852 of his personally owned shares to cover these costs. The receipt of shares from Mr. Frist and in connection with the withholding of shares as set forth above are presented on the Company’s Statement of Shareholders’ Equity in a similar manner as a share repurchase (i.e., reduction of outstanding shares).

Earnings Per Share

6 Months Ended

Jun. 30, 2019

Earnings Per Share [Abstract]

Earnings Per Share

6. EARNINGS PER SHARE

Basic earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of potentially dilutive common and common equivalent shares outstanding during the period. Common equivalent shares are composed of incremental common shares issuable upon the exercise of stock options and RSUs subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. The total number of common equivalent shares excluded from the calculations of diluted earnings per share, due to their anti-dilutive effect or contingent performance conditions, was 131,000 and 70,000 for the three months ended June 30, 2019 and 2018, respectively, and 134,000 and 114,000 for the six months ended June 30, 2019 and 2018, respectively.

The following table sets forth the computation of basic and diluted earnings per share for the three and six months ended June 30, 2019 and 2018 (in thousands, except per share data):

	Three Months Ended June 30,					Six Months Ended June 30,
	2019		2018			2019		2018
Numerator:
Income from continuing operations	$	2,401	$	3,656		$	7,181	$	7,285
(Loss) Income from discontinued operations		—		(1,111	)		1,194		19,107
Net income	$	2,401	$	2,545		$	8,375	$	26,392
Denominator:
Weighted-average shares outstanding		32,394		32,312			32,366		32,205
Effect of dilutive shares		40		66			40		50
Weighted-average diluted shares		32,434		32,378			32,406		32,255

Net income (loss) per share - basic:
Continuing operations	$	0.07	$	0.11		$	0.22	$	0.23
Discontinued operations		—		(0.03	)		0.04		0.59
Net income per share - basic	$	0.07	$	0.08		$	0.26	$	0.82

Net income (loss) per share - diluted:
Continuing operations	$	0.07	$	0.11		$	0.22	$	0.23
Discontinued operations		—		(0.03	)		0.04		0.59
Net income per share - diluted	$	0.07	$	0.08		$	0.26	$	0.82

Marketable Securities

6 Months Ended

Jun. 30, 2019

Investments Debt And Equity Securities [Abstract]

Marketable Securities

7. MARKETABLE SECURITIES

At June 30, 2019 and December 31, 2018, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	June 30, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	28,141	$	19	$	(4	)	$	28,156
Government-sponsored enterprise debt securities		12,577		4		—			12,581
Total	$	40,718	$	23	$	(4	)	$	40,737

	December 31, 2018
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	31,521	$	—	$	(23	)	$	31,498
Government-sponsored enterprise debt securities		2,999		—		—			2,999
Total	$	34,520	$	—	$	(23	)	$	34,497

The carrying amounts reported in the Condensed Consolidated Balance Sheets approximate the fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of June 30, 2019, the Company does not consider any of its marketable securities to be other than temporarily impaired. During the three and six months ended June 30, 2019 and 2018, the Company did not reclassify any items out of accumulated other comprehensive (loss) income to net income. All investments in marketable securities are classified as current assets on the balance sheet because the underlying securities mature within one year from the balance sheet date.

Discontinued Operations

6 Months Ended

Jun. 30, 2019

Discontinued Operations And Disposal Groups [Abstract]

Discontinued Operations

8. DISCONTINUED OPERATIONS

Patient Experience

On February 12, 2018, the Company divested PX to Press Ganey for $65.2 million in cash (after giving effect to the post-closing working capital adjustment), resulting in a gain, net of tax, of $20.2 million, of which $19.0 million was recorded during the year ended December 31, 2018 and $1.2 million was recorded during the three months ended March 31, 2019. Approximately $6.55 million of the proceeds was held in escrow for a period of time following the closing as a source of recovery for indemnification claims by Press Ganey, of which $6.22 million was released and paid to the Company in April 2019. Approximately $328,000 remains in escrow through August 12, 2019 as a source of recovery for certain potential indemnification claims.

This sale of the PX business resulted in the Company’s divestiture of the Company’s patient experience solutions business segment. The Company has classified the results of the patient experience solutions business segment as discontinued operations in its Condensed Consolidated Statements of Income and Cash Flows for all periods presented.

The financial results of the PX business for the period prior to divestiture during the six months ended June 30, 2018, are presented in discontinued operations in the Company’s Condensed Consolidated Statement of Income. The following table presents financial results of the PX business (in thousands):

	Six Months Ended June 30,
	2018
Revenues, net	$	3,342
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		1,982
Product development		554
Sales and marketing		460
Other general and administrative expenses		229
Depreciation and amortization		181
Total operating costs and expenses		3,406

Operating loss		(64	)

Other loss		—

Loss from discontinued operations before income tax provision		(64	)
Income tax provision		—
Loss from discontinued operations, net of income taxes	$	(64	)

Business Segments

6 Months Ended

Jun. 30, 2019

Segment Reporting [Abstract]

Business Segments

9. BUSINESS SEGMENTS

The Company provides services to healthcare organizations and other members within the healthcare industry. The Company’s services are focused on the delivery of workforce development products and services (HealthStream Workforce Solutions) and provider credentialing, privileging, and enrollment products and services (HealthStream Provider Solutions).

As noted above, the sale of the PX business on February 12, 2018 resulted in the Company’s divestiture of the Company’s Patient Experience Solutions segment. Beginning with the first quarter of 2018, the Company classified the results of its Patient Experience segment as discontinued operations in its Condensed Consolidated Statements of Income and Cash Flows for all periods presented. See Note 8 for additional information.

The Company measures segment performance based on operating income before income taxes and prior to the allocation of certain corporate overhead expenses, interest income, interest expense, and depreciation. The Unallocated component below includes corporate functions, such as accounting, human resources, legal, investor relations, administrative, and executive personnel, depreciation, a portion of amortization, and certain other expenses, which are not currently allocated in measuring segment performance. The following is the Company’s business segment information for the three and six months ended June 30, 2019 and 2018 and as of June 30, 2019 and December 31, 2018 (in thousands).

	Three Months Ended June 30,						Six Months Ended June 30,
Revenues, net:	2019			2018			2019			2018
Workforce Solutions	$	52,422		$	46,968		$	106,716		$	91,915
Provider Solutions		11,359			10,040			22,251			19,951
Total revenues, net	$	63,781		$	57,008		$	128,967		$	111,866
Operating income from continuing operations:
Workforce Solutions	$	8,890		$	9,825		$	20,419		$	19,061
Provider Solutions		1,385			776			2,821			1,289
Unallocated		(8,007	)		(6,337	)		(15,603	)		(12,356	)
Total operating income from continuing operations	$	2,268		$	4,264		$	7,637		$	7,994

Segment assets *	June 30, 2019		December 31, 2018
Workforce Solutions	$	120,066	$	104,668
Provider Solutions		141,550		145,637
Unallocated		214,835		191,643
Total assets	$	476,451	$	441,948

Segment assets include accounts and unbilled receivables, prepaid and other current assets, other assets, capitalized software development, certain property and equipment, goodwill and intangible assets. Cash and cash equivalents and marketable securities are not allocated to individual segments, and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Business Combination

6 Months Ended

Jun. 30, 2019

Business Combinations [Abstract]

Business Combination

10. BUSINESS COMBINATION

Providigm, LLC

On January 10, 2019, the Company acquired the outstanding equity of Providigm, LLC (“Providigm”), a Denver, Colorado based company focusing on quality assurance and performance improvement in healthcare, primarily serving skilled nursing facilities. The Company acquired Providigm to add its comprehensive quality management system, known as “abaqis®,” to its product portfolio and gain customers in the skilled nursing market. The consideration paid for Providigm consisted of $18.0 million in cash, which the Company funded with cash on hand. In addition, up to an additional $500,000 in cash may be paid by the Company based on the financial performance of Providigm during an 18-month period following closing. Of the purchase price paid by the Company at closing, $3.65 million is being held in escrow for a period of time following the closing to serve as a source of recovery for certain potential indemnification claims by the Company. The Company incurred $388,000 in transaction costs, of which $63,000 was incurred during the six months ended June 30, 2019 and $325,000 was incurred during the year ended 2018. The transaction costs were recorded in other general and administrative in the Condensed Consolidated Statements of Income for such periods. The results of operations for Providigm have been included in the HealthStream Workforce Solutions segment of the Company’s Financial Statements from the date of acquisition.

A summary of the purchase price is as follows (in thousands):

Cash paid at closing	$	14,368
Cash held in escrow		3,650
Total consideration paid	$	18,018

The following table summarizes the preliminary fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Accounts and unbilled receivable, net	$	898
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,157
Intangible assets		6,250
Accounts payable and accrued liabilities		(1,196	)
Deferred revenue		(141	)
Operating lease liabilities		(1,233	)
Net assets acquired	$	18,018

The excess of preliminary purchase price over the preliminary fair values of net tangible and intangible assets is recorded as goodwill. The preliminary fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. During the three months ended June 30, 2019, the Company updated the composition and valuation of intangible assets and recorded a measurement period adjustment increasing goodwill and decreasing intangible assets by approximately $2.0 million. The measurement period adjustment resulted in a decrease to depreciation and amortization expense of $113,000 during the three months ended June 30, 2019. The preliminary fair values of assets acquired and liabilities assumed continue to be subject to change during the measurement period (up to one year from the acquisition date) as the Company finalizes the valuation of these items. The primary areas of the preliminary purchase price allocation that are not finalized include the composition and valuation of intangible assets and indemnification asset and liability. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering Providigm’s products, and expected synergies from integrating Providigm with other products or other combined functional areas within the Company. The goodwill balance is deductible for U.S. income tax purposes. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $266,000 to an estimated fair value of $141,000. The $125,000 write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services. The acquired assets and liabilities include a $750,000 indemnification asset and liability related to tax liabilities. The purchase agreement also contains a provision for up to $500,000 of additional consideration based on the achievement of financial performance targets by Providigm during an 18-month period following the closing date. Management assessed the likelihood of achieving the financial performance targets, which has been included in the preliminary purchase price allocation.

The following table sets forth the preliminary components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):

	Preliminary Fair Value		Useful life
Customer relationships	$	3,200	12 years
Developed technology		2,800	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	6,250

The amounts of revenue and operating loss of Providigm included in the Company’s Condensed Consolidated Statements of Income from the date of acquisition of January 10, 2019 to the three and six months ended June 30, 2019 are as follows (in thousands):

	Three Months Ended June 30, 2019			Six Months Ended June 30, 2019
Total revenues	$	1,844		$	3,336
Operating loss	$	(90	)	$	(488	)

The following unaudited pro forma financial information summarizes the combined results of continuing and discontinued operations of the Company, unless otherwise noted, and Providigm as though the companies were combined as of January 1, 2018 (in thousands, except per share data):

	Three Months Ended June 30,				Six Months Ended June 30,
	2019		2018		2019		2018
Total revenues	$	63,781	$	59,412	$	129,278	$	119,600
Income from continuing operations	$	2,401	$	3,580	$	7,235	$	7,098
Net income	$	2,401	$	2,469	$	8,429	$	26,204
Net income per share - basic	$	0.07	$	0.08	$	0.26	$	0.81
Net income per share - diluted	$	0.07	$	0.08	$	0.26	$	0.81

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, interest expense related to Providigm’s previously outstanding debt, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not indicative of what the Company’s results of operations would have been had the transaction occurred at the beginning of the earliest period presented or to project the Company’s results of operations in any future period.

Debt

6 Months Ended

Jun. 30, 2019

Debt Disclosure [Abstract]

Debt

11. DEBT

Revolving Credit Facility

On December 31, 2018, the Company entered into a Second Amendment to its Revolving Credit Agreement, dated as of November 24, 2014 (as amended, the “Revolving Credit Facility”), with SunTrust Bank (“SunTrust”), which extended the maturity date to November 24, 2020. Under the Revolving Credit Facility, the Company may borrow up to $50.0 million, which includes a $5.0 million swing line sub-facility and a $5.0 million letter of credit sub-facility, as well as an accordion feature that allows the Company to increase the Revolving Credit Facility by a total of up to $25.0 million, subject to securing additional commitments from existing lenders or new lending institutions. The obligations under the Revolving Credit Facility are guaranteed by each of the Company’s subsidiaries. At the Company’s election, the borrowings under the Revolving Credit Facility bear interest at either (1) a rate per annum equal to the highest of SunTrust’s prime rate or 0.5% in excess of the Federal Funds Rate or 1.0% in excess of one-month LIBOR (the “Base Rate”), plus an applicable margin, or (2) the one, two, three, or six month per annum LIBOR for deposits in the applicable currency (the “Eurocurrency Rate”), as selected by the Company, plus an applicable margin. The applicable margin for Eurocurrency Rate loans depends on the Company’s funded debt leverage ratio and varies from 1.50% to 2.00%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 1.50%. Commitment fees and letter of credit fees are also payable under the Revolving Credit Facility. Principal is payable in full at maturity on November 24, 2020, and there are no scheduled principal payments prior to maturity. The Company is required to pay a commitment fee ranging between 20 and 30 basis points per annum of the average daily unused portion of the Revolving Credit Facility, depending on the Company’s funded debt leverage ratio.

The purpose of the Revolving Credit Facility is for general working capital needs, permitted acquisitions (as defined in the Revolving Credit Facility), and for stock repurchase and/or redemption transactions that the Company may authorize.

The Revolving Credit Facility contains certain covenants that, among other things, restrict additional indebtedness, liens and encumbrances, changes to the character of the Company’s business, acquisitions, asset dispositions, mergers and consolidations, sale or discount of receivables, creation or acquisitions of additional subsidiaries, and other matters customarily restricted in such agreements.

In addition, the Revolving Credit Facility requires the Company to meet certain financial tests, including, without limitation:

•	a funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not greater than 3.0 to 1.0; and

•	an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not less than 3.0 to 1.0.

As of June 30, 2019, the Company was in compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of or during the three and six months ended June 30, 2019.

Leases

6 Months Ended

Jun. 30, 2019

Leases [Abstract]

Leases

12. LEASES

Effective January 1, 2019, the Company adopted ASC 842, which requires an entity to recognize a right-of-use (“ROU”) asset and a lease liability on the balance sheet for substantially all leases, including operating leases, using the modified retrospective approach. The Company elected to use the package of practicable expedients which allows companies to not reassess the following: (1) the lease classification for any expired or existing leases, (2) the treatment of initial direct costs as they related to existing leases, and (3) whether expired or existing contracts are or contain leases. The Company did not elect the use of the hindsight practical expedient, but did elect the practical expedient not to separate lease components from non-lease components related to its office space leases.

Upon adoption of ASC 842, the Company had non-cancellable operating leases for office space subject to recognition as ROU assets. Accordingly, on January 1, 2019 the Company recorded $4.8 million in ROU assets and $6.4 million in operating lease liabilities (the difference of $1.6 million related to existing deferred rent liabilities as of December 31, 2018 which had the effect of reducing the ROU asset upon adoption). During 2019, the Company acquired an operating lease as part of its acquisition of Providigm, resulting in a $1.2 million ROU asset and lease liability, and another operating lease for office space commenced for the Company’s new corporate headquarters in Nashville, TN, resulting in a $26.5 million ROU asset and lease liability. As of June 30, 2019, the Company does not have any leases that have not yet commenced.

The Company does not have any lease contracts that contain: (1) an option to extend that the Company is reasonably certain to exercise, (2) an option to terminate that the Company is reasonably certain not to exercise, or (3) an option to extend (or not to terminate) in which exercise of the option is controlled by the lessor. Additionally, the Company does not have any leases with residual value guarantees or material restrictive covenants. For leases already commenced, the lease term was determined to be the remaining months in the lease term as of January 1, 2019, the date of adoption. The Company has elected not to recognize leases with initial terms of one year or less on the balance sheet. Lease liabilities and their corresponding right-of-use assets have been recorded based on the present value of the future lease payments over the expected lease term. Most of the Company’s lease agreements contain provisions for escalating rent payments over the terms of the leases.

The Company’s leases do not contain readily determinable implicit discount rates, and as such the Company must use its incremental borrowing rate to discount the future lease payments based on information available at lease commencement. The incremental borrowing rate was estimated by determining the rate of interest that the Company would have to pay to borrow on a collateralized basis over a similar term an amount equal to the lease payments in a similar economic environment.

The Company’s operating lease cost as presented in other general and administrative expense in the Condensed Consolidated Statement of Income was $1.4 million and $2.6 million for the three and six months ended June 30, 2019, respectively. Cash paid for amounts included in the measurement of operating lease liabilities was $1.1 million for the six months ended June 30, 2019. As of June 30, 2019, the weighted-average remaining lease term was 11.0 years, and the weighted-average incremental borrowing rate was 6%.

The table below presents the lease-related assets and liabilities recorded on the Condensed Consolidated Balance Sheet as of June 30, 2019 (in thousands).

Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	30,774
Total leased assets		$	30,774
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	1,693
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		32,046
Total operating lease liabilities		$	33,739

The table below presents the maturities of lease liabilities under non-cancellable leases as of June 30, 2019 (in thousands).

2019		1,353
2020		4,705
2021		4,505
2022		4,124
2023		3,979
Thereafter		28,655
Total undiscounted lease payments		47,321
Less imputed interest		13,582
Total lease liabilities	$	33,739

Non-Marketable Equity Investments

6 Months Ended

Jun. 30, 2019

Investments Debt And Equity Securities [Abstract]

Non-Marketable Equity Investments

13. NON-MARKETABLE EQUITY INVESTMENTS

Non-marketable equity investments, where the Company is not able to exercise significant influence over the investee, are accounted for under the cost method. ASU 2016-01, Financial Instruments – Overall (Subtopic 825-10), became effective for the Company as of January 1, 2018 and requires equity investments (except those accounted for under the equity method of accounting or those that result in consolidation of the investee) to be measured at fair value with changes in fair value recognized in net income. The aggregate carrying amount of all cost method investments was $5.4 million and $2.1 million as of June 30, 2019 and December 31, 2018, respectively, which carrying value we evaluate for impairment at each reporting period. Cumulatively, the Company has recorded $1.3 million in reductions to the carrying value of cost method investments due to downward changes in fair value based on observable prices from orderly transactions for similar investments made in the investee. The fair value of cost method investments is not estimated if there are no identified events or changes in circumstances that may have a significant adverse effect on the fair value of the investment.

Recent Accounting Pronouncements (Policies)

6 Months Ended

Jun. 30, 2019

Accounting Changes And Error Corrections [Abstract]

Accounting Standards Recently Adopted/Not Yet Adopted

Accounting Standards Recently Adopted

Accounting Standards Not Yet Adopted

Revenue Recognition And Sales Commissions (Tables)

6 Months Ended

Jun. 30, 2019

Revenue From Contract With Customer [Abstract]

Schedule of Revenues Included in Continuing Operations from Contracts with Customers Disaggregated by Revenue Source

	Three Months Ended June 30, 2019						Six Months Ended June 30, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated		Workforce Solutions		Provider Solutions		Consolidated
Subscription/SaaS services	$	50,892	$	9,501	$	60,393	$	103,696	$	18,581	$	122,277
Professional services		1,530		1,858		3,388		3,020		3,670		6,690
Total revenues, net	$	52,422	$	11,359	$	63,781	$	106,716	$	22,251	$	128,967

	Three Months Ended June 30, 2018						Six Months Ended June 30, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated		Workforce Solutions		Provider Solutions		Consolidated
Subscription/SaaS services	$	45,743	$	8,667	$	54,410	$	89,444	$	17,700	$	107,144
Professional services		1,225		1,373		2,598		2,471		2,251		4,722
Total revenues, net	$	46,968	$	10,040	$	57,008	$	91,915	$	19,951	$	111,866

Shareholders' Equity (Tables)

6 Months Ended

Jun. 30, 2019

Equity [Abstract]

Stock Based Compensation Expense Recorded Within Continuing Operations in Condensed Consolidated Statements of Income

	Three Months Ended June 30,				Six Months Ended June 30,
	2019		2018		2019		2018
Cost of revenues (excluding depreciation and amortization)	$	670	$	10	$	671	$	18
Product development		765		72		818		145
Sales and marketing		462		50		518		82
Other general and administrative		661		295		1,067		601
Total stock based compensation expense	$	2,558	$	427	$	3,074	$	846

Earnings Per Share (Tables)

6 Months Ended

Jun. 30, 2019

Earnings Per Share [Abstract]

Computation of Basic and Diluted Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share for the three and six months ended June 30, 2019 and 2018 (in thousands, except per share data):

	Three Months Ended June 30,					Six Months Ended June 30,
	2019		2018			2019		2018
Numerator:
Income from continuing operations	$	2,401	$	3,656		$	7,181	$	7,285
(Loss) Income from discontinued operations		—		(1,111	)		1,194		19,107
Net income	$	2,401	$	2,545		$	8,375	$	26,392
Denominator:
Weighted-average shares outstanding		32,394		32,312			32,366		32,205
Effect of dilutive shares		40		66			40		50
Weighted-average diluted shares		32,434		32,378			32,406		32,255

Net income (loss) per share - basic:
Continuing operations	$	0.07	$	0.11		$	0.22	$	0.23
Discontinued operations		—		(0.03	)		0.04		0.59
Net income per share - basic	$	0.07	$	0.08		$	0.26	$	0.82

Net income (loss) per share - diluted:
Continuing operations	$	0.07	$	0.11		$	0.22	$	0.23
Discontinued operations		—		(0.03	)		0.04		0.59
Net income per share - diluted	$	0.07	$	0.08		$	0.26	$	0.82

Marketable Securities (Tables)

6 Months Ended

Jun. 30, 2019

Investments Debt And Equity Securities [Abstract]

Fair Value of Available for Sale Marketable Securities

At June 30, 2019 and December 31, 2018, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	June 30, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	28,141	$	19	$	(4	)	$	28,156
Government-sponsored enterprise debt securities		12,577		4		—			12,581
Total	$	40,718	$	23	$	(4	)	$	40,737

	December 31, 2018
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	31,521	$	—	$	(23	)	$	31,498
Government-sponsored enterprise debt securities		2,999		—		—			2,999
Total	$	34,520	$	—	$	(23	)	$	34,497

Discontinued Operations (Tables)

6 Months Ended

Jun. 30, 2019

Discontinued Operations And Disposal Groups [Abstract]

Schedule of Discontinued Operations, Income Statement

The following table presents financial results of the PX business (in thousands):

	Six Months Ended June 30,
	2018
Revenues, net	$	3,342
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		1,982
Product development		554
Sales and marketing		460
Other general and administrative expenses		229
Depreciation and amortization		181
Total operating costs and expenses		3,406

Operating loss		(64	)

Other loss		—

Loss from discontinued operations before income tax provision		(64	)
Income tax provision		—
Loss from discontinued operations, net of income taxes	$	(64	)

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

+ References

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Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1361-107760

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721671-107760

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5B
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721673-107760

Reference 13: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 4A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721663-107760

+ Details

Business Segments (Tables)

6 Months Ended

Jun. 30, 2019

Segment Reporting [Abstract]

Business Segment Information Based on Net Revenues and Operating Income

The following is the Company’s business segment information for the three and six months ended June 30, 2019 and 2018 and as of June 30, 2019 and December 31, 2018 (in thousands).

	Three Months Ended June 30,						Six Months Ended June 30,
Revenues, net:	2019			2018			2019			2018
Workforce Solutions	$	52,422		$	46,968		$	106,716		$	91,915
Provider Solutions		11,359			10,040			22,251			19,951
Total revenues, net	$	63,781		$	57,008		$	128,967		$	111,866
Operating income from continuing operations:
Workforce Solutions	$	8,890		$	9,825		$	20,419		$	19,061
Provider Solutions		1,385			776			2,821			1,289
Unallocated		(8,007	)		(6,337	)		(15,603	)		(12,356	)
Total operating income from continuing operations	$	2,268		$	4,264		$	7,637		$	7,994

Business Segment Information Based on Assets

Segment assets *	June 30, 2019		December 31, 2018
Workforce Solutions	$	120,066	$	104,668
Provider Solutions		141,550		145,637
Unallocated		214,835		191,643
Total assets	$	476,451	$	441,948

Business Combination (Tables) - Providigm, LLC [Member]

6 Months Ended

Jun. 30, 2019

Summary of Purchase Price

A summary of the purchase price is as follows (in thousands):

Cash paid at closing	$	14,368
Cash held in escrow		3,650
Total consideration paid	$	18,018

Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed

The following table summarizes the preliminary fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Accounts and unbilled receivable, net	$	898
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,157
Intangible assets		6,250
Accounts payable and accrued liabilities		(1,196	)
Deferred revenue		(141	)
Operating lease liabilities		(1,233	)
Net assets acquired	$	18,018

Summary of Preliminary Components of Identifiable Intangible Assets and Estimated Useful Lives

The following table sets forth the preliminary components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):

	Preliminary Fair Value		Useful life
Customer relationships	$	3,200	12 years
Developed technology		2,800	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	6,250

Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statements of Income from the Date of Acquisition

	Three Months Ended June 30, 2019			Six Months Ended June 30, 2019
Total revenues	$	1,844		$	3,336
Operating loss	$	(90	)	$	(488	)

Summary of Unaudited Pro Forma Financial Information

	Three Months Ended June 30,				Six Months Ended June 30,
	2019		2018		2019		2018
Total revenues	$	63,781	$	59,412	$	129,278	$	119,600
Income from continuing operations	$	2,401	$	3,580	$	7,235	$	7,098
Net income	$	2,401	$	2,469	$	8,429	$	26,204
Net income per share - basic	$	0.07	$	0.08	$	0.26	$	0.81
Net income per share - diluted	$	0.07	$	0.08	$	0.26	$	0.81

Leases (Tables)

6 Months Ended

Jun. 30, 2019

Leases [Abstract]

Schedule of Lease-Related Assets and Liabilities Recorded on Condensed Consolidated Balance Sheet

The table below presents the lease-related assets and liabilities recorded on the Condensed Consolidated Balance Sheet as of June 30, 2019 (in thousands).

Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	30,774
Total leased assets		$	30,774
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	1,693
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		32,046
Total operating lease liabilities		$	33,739

Schedule of Maturities of Lease Liabilities Under Non-cancellable Leases

The table below presents the maturities of lease liabilities under non-cancellable leases as of June 30, 2019 (in thousands).

2019		1,353
2020		4,705
2021		4,505
2022		4,124
2023		3,979
Thereafter		28,655
Total undiscounted lease payments		47,321
Less imputed interest		13,582
Total lease liabilities	$	33,739

Revenue Recognition and Sales Commissions - Schedule of Revenues Included in Continuing Operations from Contracts with Customers Disaggregated by Revenue Source (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 63,781	$ 57,008	$ 128,967	$ 111,866
Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	52,422	46,968	106,716	91,915
Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	11,359	10,040	22,251	19,951
Subscription SaaS Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	60,393	54,410	122,277	107,144
Subscription SaaS Services [Member] \| Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	50,892	45,743	103,696	89,444
Subscription SaaS Services [Member] \| Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	9,501	8,667	18,581	17,700
Professional Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	3,388	2,598	6,690	4,722
Professional Services [Member] \| Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	1,530	1,225	3,020	2,471
Professional Services [Member] \| Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 1,858	$ 1,373	$ 3,670	$ 2,251

Revenue Recognition and Sales Commissions - Additional Information (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Revenue Recognition and Sales Commissions [Line Items]
Revenue recognized in period, included in deferred revenue at beginning of the period	$ 36,300,000	$ 33,800,000	$ 51,200,000	$ 48,000,000.0
Estimated revenue expected to be recognized in future under contract with customers	436,000,000		$ 436,000,000
Description of sales commission plan			Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer. The Company’s sales commission plans for 2018 and 2019 typically include multiple payments, including initial payments in the period a customer contract is obtained and subsequent payments either 15 or 27 months after the initial payment.
Sales Commissions, amortization term description			Non-commensurate commissions are amortized over the greater of the expected period of benefit or technological obsolescence period.
Amortization of deferred commissions	2,100,000	1,900,000	$ 4,201,000	3,735,000
Customer Contracts [Member]
Revenue Recognition and Sales Commissions [Line Items]
Impairment losses on receivables and contract asset	$ 46,000	$ 0	$ 48,000	$ 390,000
Subscription SaaS Services [Member]
Revenue Recognition and Sales Commissions [Line Items]
Description of contracts with customer			Subscription/SaaS contracts are generally non-cancelable, one to five years in length, and billed annually, semi-annually, quarterly, or monthly in advance.
Subscription SaaS Services [Member] \| Minimum [Member]
Revenue Recognition and Sales Commissions [Line Items]
Period of contract with customer			1 year
Subscription SaaS Services [Member] \| Maximum [Member]
Revenue Recognition and Sales Commissions [Line Items]
Period of contract with customer			5 years

Revenue Recognition and Sales Commissions - Additional Information (Detail 1) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date: 2019-07-01	Jun. 30, 2019
Revenue Recognition and Sales Commissions [Line Items]
Percentage of remaining performance obligations expects revenue	47.00%
Estimated revenue, expected recognition period	12 months

Income Taxes - Additional Information (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Taxes Disclosure [Line Items]
Income tax provision	$ 719,000	$ 1,084,000	$ 2,130,000	$ 1,498,000
Effective tax rate for continuing operations			23.00%	17.00%
Accounting Standards Update 2016-09 [Member]
Income Taxes Disclosure [Line Items]
Excess tax benefits primarily from stock option exercises			$ 123,000	$ 663,000

Shareholders' Equity - Additional Information (Detail) $ / shares in Units, $ in Thousands				1 Months Ended	3 Months Ended		6 Months Ended
	Jun. 30, 2019 shares	Jun. 26, 2019 USD ($) Employee shares	Feb. 12, 2018 $ / shares	Jun. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Jun. 30, 2018 USD ($)	Jun. 30, 2019 USD ($) Incentive_Plan $ / shares shares	Jun. 30, 2018 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Dividend declared date							Feb. 12, 2018
Special cash dividend \| $ / shares			$ 1.00
Dividend payable date							Apr. 03, 2018
Dividend record date							Mar. 06, 2018
Number of incentive plans \| Incentive_Plan							2
Stock based compensation expense					$ 2,558	$ 427	$ 3,074	$ 846
Payments related to employees’ tax obligations to taxing authorities for stock awards							$ 627
Employer tax and expenses for stock awards				$ 200
Chief Executive Officer, Robert A. Frist, Jr., [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares contributed to the company \| shares		78,520
Value of shares contributed to the company		$ 2,000
Number of additional shares contributed to the company \| shares	7,852
RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted share units issued \| shares							86,220	83,168
Weighted average grant date fair value, restricted share unit \| $ / shares							$ 27.39	$ 24.70
2016 Omnibus Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vested \| shares		78,520
Number of employees awarded fully vested shares \| Employee		820
Stock based compensation expense					$ 2,000

Shareholders' Equity - Stock Based Compensation Expense Recorded Within Continuing Operations in Condensed Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 2,558	$ 427	$ 3,074	$ 846
Cost of Revenues (Excluding Depreciation and Amortization) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	670	10	671	18
Product Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	765	72	818	145
Sales and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	462	50	518	82
Other General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 661	$ 295	$ 1,067	$ 601

Earnings Per Share - Additional Information (Detail) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Earnings Per Share [Abstract]
Total number of common equivalent shares excluded from the calculations of diluted earnings per share	131,000	70,000	134,000	114,000

Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Jun. 30, 2018
Numerator:
Income from continuing operations	$ 2,401		$ 3,656		$ 7,181	$ 7,285
(Loss) Income from discontinued operations			(1,111)		1,194	19,107
Net income	$ 2,401	$ 5,974	$ 2,545	$ 23,846	$ 8,375	$ 26,392
Denominator:
Weighted-average shares outstanding	32,394		32,312		32,366	32,205
Effect of dilutive shares	40		66		40	50
Weighted-average diluted shares	32,434		32,378		32,406	32,255
Net income (loss) per share - basic:
Continuing operations	$ 0.07		$ 0.11		$ 0.22	$ 0.23
Discontinued operations			(0.03)		0.04	0.59
Net income per share - basic	0.07		0.08		0.26	0.82
Net income (loss) per share - diluted:
Continuing operations	0.07		0.11		0.22	0.23
Discontinued operations			(0.03)		0.04	0.59
Net income per share - diluted	$ 0.07		$ 0.08		$ 0.26	$ 0.82

Marketable Securities - Fair Value of Available for Sale Marketable Securities (Detail) - Level 2 [Member] - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	$ 40,718	$ 34,520
Available for sale securities, Unrealized Gains	23
Available for sale securities, Unrealized Losses	(4)	(23)
Available for sale securities, Fair Value	40,737	34,497
Corporate Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	28,141	31,521
Available for sale securities, Unrealized Gains	19
Available for sale securities, Unrealized Losses	(4)	(23)
Available for sale securities, Fair Value	28,156	31,498
Government-Sponsored Enterprises Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	12,577	2,999
Available for sale securities, Unrealized Gains	4
Available for sale securities, Fair Value	$ 12,581	$ 2,999

Discontinued Operations - Additional Information (Detail) - Patient Experience Solutions [Member] - USD ($)		1 Months Ended	3 Months Ended	12 Months Ended
	Feb. 12, 2018	Apr. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Aug. 12, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration received	$ 65,200,000
Gain on sale of business, net of tax	20,200,000		$ 1,200,000	$ 19,000,000.0
Escrow deposit	$ 6,550,000
Cash proceeds from escrow		$ 6,220,000
Scenario Forecast [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Escrow deposit					$ 328,000

Discontinued Operations - Schedule of Discontinued Operations Income Statement (Detail) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Operating costs and expenses:
Loss from discontinued operations before income tax provision			$ (64)
Income tax provision	$ (391)	$ 426	10,319
(Loss) Income from discontinued operations	$ (1,111)	$ 1,194	19,107
Patient Experience Solutions [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenues, net			3,342
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)			1,982
Product development			554
Sales and marketing			460
Other general and administrative expenses			229
Depreciation and amortization			181
Total operating costs and expenses			3,406
Operating loss			(64)
Loss from discontinued operations before income tax provision			(64)
(Loss) Income from discontinued operations			$ (64)

Business Segments - Additional Information (Detail)	6 Months Ended
Business Segments - Additional Information (Detail)	Jun. 30, 2019
Patient Experience Solutions [Member]
Segment Reporting Information [Line Items]
Date of business segment sold	Feb. 12, 2018

Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Revenues, net:
Revenues, net	$ 63,781	$ 57,008	$ 128,967	$ 111,866
Operating income from continuing operations:
Operating income from continuing operations	2,268	4,264	7,637	7,994
Workforce Solutions [Member]
Revenues, net:
Revenues, net	52,422	46,968	106,716	91,915
Provider Solutions [Member]
Revenues, net:
Revenues, net	11,359	10,040	22,251	19,951
Operating Segments [Member] \| Workforce Solutions [Member]
Revenues, net:
Revenues, net	52,422	46,968	106,716	91,915
Operating income from continuing operations:
Operating income from continuing operations	8,890	9,825	20,419	19,061
Operating Segments [Member] \| Provider Solutions [Member]
Revenues, net:
Revenues, net	11,359	10,040	22,251	19,951
Operating income from continuing operations:
Operating income from continuing operations	1,385	776	2,821	1,289
Unallocated [Member]
Operating income from continuing operations:
Operating income from continuing operations	$ (8,007)	$ (6,337)	$ (15,603)	$ (12,356)

Business Segments - Business Segment Information Based on Assets (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Total assets	$ 476,451	$ 441,948
Operating Segments [Member] \| Workforce Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	120,066	104,668
Operating Segments [Member] \| Provider Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	141,550	145,637
Unallocated [Member]
Segment Reporting Information [Line Items]
Total assets	$ 214,835	$ 191,643

Business Combination - Additional Information (Detail) - Providigm, LLC [Member] - USD ($)		3 Months Ended	6 Months Ended	12 Months Ended	18 Months Ended
	Jan. 10, 2019	Jun. 30, 2019	Jun. 30, 2019	Dec. 31, 2018	Jun. 30, 2019
Business Acquisition [Line Items]
Consideration paid for acquisition in cash	$ 18,018,000
Additional contingent consideration	500,000
Transaction costs			$ 63,000	$ 325,000	$ 388,000
Net tangible assets include deferred revenue book value at acquisition date	266,000
Net tangible assets include deferred revenue fair value at acquisition date	141,000
Write-down of deferred revenue	125,000
Business combination, indemnification assets and liability related to tax liabilities	$ 750,000
Measurement period adjustment increase in goodwill resulting in decrease in intangible assets		$ 2,000,000.0
Measurement period adjustment decrease in depreciation and amortization expense		$ 113,000
Maximum [Member]
Business Acquisition [Line Items]
Preliminary purchase price allocation measurement period from acquisition date	1 year
Recovery of Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow	$ 3,650,000

Business Combination - Summary of Purchase Price (Detail) - Providigm, LLC [Member] $ in Thousands	Jan. 10, 2019 USD ($)
Business Acquisition [Line Items]
Total consideration paid	$ 18,018
Cash Paid at Closing [Member]
Business Acquisition [Line Items]
Total consideration paid	14,368
Cash Held in Escrow [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 3,650

Business Combination - Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed (Detail) - USD ($)	Jun. 30, 2019	Jan. 10, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill	$ 97,300,000		$ 86,144,000
Providigm, LLC [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net		$ 898,000
Prepaid assets		847,000
Property and equipment		50,000
Operating lease right-of-use assets		1,233,000
Other assets		49,000
Deferred tax assets		104,000
Goodwill		11,157,000
Intangible assets		6,250,000
Accounts payable and accrued liabilities		(1,196,000)
Deferred revenue		(141,000)
Operating lease liabilities		(1,233,000)
Net assets acquired		$ 18,018,000

Business Combination - Summary of Preliminary Components of Identifiable Intangible Assets and Estimated Useful Lives (Detail) - Providigm, LLC [Member] $ in Thousands	Jan. 10, 2019 USD ($)
Business Acquisition [Line Items]
Preliminary Fair Value	$ 6,250
Customer Relationships [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 3,200
Useful life	12 years
Developed Technology [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 2,800
Useful life	5 years
Trade Name [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 250
Useful life	7 years

Business Combination - Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statements of Income from the Date of Acquisition (Detail) - Providigm, LLC [Member] - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Business Acquisition [Line Items]
Total revenues	$ 1,844	$ 3,336
Operating loss	$ (90)	$ (488)

Business Combination - Summary of Unaudited Pro Forma Financial Information (Detail) - Providigm, LLC [Member] - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Business Acquisition [Line Items]
Total revenues	$ 63,781	$ 59,412	$ 129,278	$ 119,600
Income from continuing operations	2,401	3,580	7,235	7,098
Net income	$ 2,401	$ 2,469	$ 8,429	$ 26,204
Net income per share - basic	$ 0.07	$ 0.08	$ 0.26	$ 0.81
Net income per share - diluted	$ 0.07	$ 0.08	$ 0.26	$ 0.81

Debt - Additional Information (Detail) - SunTrust Bank [Member] - USD ($)		6 Months Ended
	Dec. 31, 2018	Jun. 30, 2019
Line of Credit Facility [Line Items]
Description of Line of credit facility Covenant		A funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not greater than 3.0 to 1.0; and an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not less than 3.0 to 1.0.
Minimum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.20%
Maximum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.30%
Revolving Credit Facility [Member]
Line of Credit Facility [Line Items]
Maturity date of Loan agreement	Nov. 24, 2020
Interest rate under credit facility		the borrowings under the Revolving Credit Facility bear interest at either (1) a rate per annum equal to the highest of SunTrust’s prime rate or 0.5% in excess of the Federal Funds Rate or 1.0% in excess of one-month LIBOR (the “Base Rate”), plus an applicable margin, or (2) the one, two, three, or six month per annum LIBOR for deposits in the applicable currency (the “Eurocurrency Rate”), as selected by the Company, plus an applicable margin. The applicable margin for Eurocurrency Rate loans depends on the Company’s funded debt leverage ratio and varies from 1.50% to 2.00%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 1.50%
Maximum borrowing capacity under credit facility	$ 50,000,000.0
Increase in revolving credit facility	25,000,000.0
Principal payments prior to maturity	0
Outstanding balance on revolving credit facility		$ 0
Revolving Credit Facility [Member] \| Swing Line Sub Facility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	5,000,000.0
Revolving Credit Facility [Member] \| Letter of Credit Subfacility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	$ 5,000,000.0
Revolving Credit Facility [Member] \| Federal Funds Effective Swap Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	0.50%
Revolving Credit Facility [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	1.00%
Revolving Credit Facility [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Interest coverage ratio	300.00%
Revolving Credit Facility [Member] \| Minimum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	0.50%
Revolving Credit Facility [Member] \| Minimum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%
Revolving Credit Facility [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Debt leverage ratio	300.00%
Revolving Credit Facility [Member] \| Maximum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%
Revolving Credit Facility [Member] \| Maximum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	2.00%

Leases - Additional Information (Detail) - USD ($)	3 Months Ended	6 Months Ended
Leases - Additional Information (Detail) - USD ($)	Jun. 30, 2019	Jun. 30, 2019	Jan. 01, 2019	Dec. 31, 2018
Lessee, Lease, Description [Line Items]
Right-of-use assets	$ 30,774,000	$ 30,774,000	$ 4,800,000
Operating lease, liability	33,739,000	33,739,000	$ 6,400,000
Deferred rent liabilities				$ 1,600,000
Operating leases that have not yet commenced		0
Operating lease cost	$ 1,400,000	2,600,000
Cash paid for amounts included in the measurement of operating lease liabilities		$ 1,100,000
Operating lease, weighted-average remaining lease term	11 years	11 years
Operating lease, weighted-average incremental borrowing rate	6.00%	6.00%
Nashville, TN [Member]
Lessee, Lease, Description [Line Items]
Right-of-use assets	$ 26,500,000	$ 26,500,000
Operating lease, liability	26,500,000	26,500,000
Providigm, LLC [Member]
Lessee, Lease, Description [Line Items]
Right-of-use assets	1,200,000	1,200,000
Operating lease, liability	$ 1,200,000	$ 1,200,000

Leases - Schedule of Lease-Related Assets and Liabilities Recorded on Condensed Consolidated Balance Sheet (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Jan. 01, 2019
ASSETS
Operating lease right of use assets, net	$ 30,774	$ 4,800
Liabilities
Operating lease liabilities, current	$ 1,693
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent
Operating lease liability, noncurrent	$ 32,046
Total operating lease liabilities	$ 33,739	$ 6,400

Leases - Schedule of Maturities of Lease Liabilities Under Non-cancellable Leases (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Jan. 01, 2019
Leases [Abstract]
2019	$ 1,353
2020	4,705
2021	4,505
2022	4,124
2023	3,979
Thereafter	28,655
Total undiscounted lease payments	47,321
Less imputed interest	13,582
Total lease liabilities	$ 33,739	$ 6,400

Non-Marketable Equity Investments - Additional Information (Detail) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2019	Dec. 31, 2018
Investments Debt And Equity Securities [Abstract]
Reduction to carrying value of cost method investment due to downward change in fair value	$ 1.3
Aggregate carrying amount of cost method investments	$ 5.4	$ 2.1