0001564590-20-006849 | 10-K | XBRL Viewer

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Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2019	Feb. 24, 2020	Jun. 30, 2019
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Trading Symbol	HSTM
Entity Registrant Name	HEALTHSTREAM INC
Entity Central Index Key	0001095565
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		32,379,741
Entity Public Float			$ 671.1
Entity Shell Company	false
Entity File Number	000-27701
Entity Tax Identification Number	62-1443555
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	TN
Entity Address, Postal Zip Code	37203
City Area Code	615
Local Phone Number	301-3100
Entity Interactive Data Current	Yes
Entity Incorporation, State or Country Code	TN
Document Annual Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock (Par Value $0.00)
Security Exchange Name	NASDAQ
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the Registrant’s definitive Proxy Statement for its 2020 Annual Meeting of Shareholders are incorporated by reference into Part III hereof.

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 131,538	$ 134,321
Marketable securities	41,328	34,497
Accounts receivable, net of allowance for doubtful accounts of $843 and $1,161 at December 31, 2019 and 2018, respectively	27,650	38,124
Accounts receivable - unbilled	2,726	2,880
Prepaid royalties, net of amortization	11,898	13,596
Other prepaid expenses and other current assets	9,432	18,016
Total current assets	224,572	241,434
Property and equipment, net of accumulated depreciation of $19,291 and $20,827 at December 31, 2019 and 2018, respectively	26,065	15,866
Capitalized software development, net of accumulated amortization of $57,768 and $46,757 at December 31, 2019 and 2018, respectively	21,445	18,352
Operating lease right of use assets, net	29,615
Goodwill	102,196	86,144
Intangible assets, net	60,081	59,378
Deferred tax assets	269	145
Deferred commissions	17,645	16,470
Non-marketable equity investments	6,782	3,376
Other assets	874	783
Total assets	489,544	441,948
Current liabilities:
Accounts payable	4,810	8,497
Accrued royalties	16,736	15,756
Accrued liabilities	18,128	16,540
Deferred revenue	65,511	66,061
Total current liabilities	105,185	106,854
Deferred tax liabilities	13,183	11,068
Deferred revenue, non-current	1,918	2,868
Operating lease liability, non-current	30,733
Other long-term liabilities	357	2,211
Commitments and contingencies
Shareholders’ equity:
Common stock, no par value, 75,000 shares authorized; 32,379 and 32,325 shares issued and outstanding at December 31, 2019 and 2018, respectively	290,021	286,597
Retained earnings	48,143	32,373
Accumulated other comprehensive income (loss)	4	(23)
Total shareholders’ equity	338,168	318,947
Total liabilities and shareholders’ equity	489,544	441,948
Customer-Related Intangible Assets [Member]
Current assets:
Intangible assets, net	52,554	53,469
Other Intangible Assets [Member]
Current assets:
Intangible assets, net	$ 7,527	$ 5,909

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Allowance for doubtful accounts, net	$ 843	$ 1,161
Accumulated depreciation on property and equipment	19,291	20,827
Accumulated amortization on capitalized software development	57,768	46,757
Accumulated amortization on intangible assets	$ 42,495	$ 32,908
Common stock, no par value
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	32,379,000	32,325,000
Common stock, shares outstanding	32,379,000	32,325,000
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 29,760	$ 23,245
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 12,735	$ 9,663

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Revenues, net	$ 254,112	$ 231,616	$ 214,899
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	103,890	96,014	87,208
Product development	29,109	25,735	24,148
Sales and marketing	37,945	35,698	38,606
Other general and administrative expenses	40,579	34,447	31,483
Depreciation and amortization	27,869	24,231	24,047
Total operating costs and expenses	239,392	216,125	205,492
Operating income	14,720	15,491	9,407
Other income, net	3,209	1,084	733
Income from continuing operations before income tax provision	17,929	16,575	10,140
Income tax provision	3,733	3,324	1,302
Income from continuing operations	14,196	13,251	8,838
(Loss) income from discontinued operations before income tax provision		(64)	393
Gain on sale of discontinued operations	2,053	29,489
Income tax provision (benefit)	479	10,459	(773)
Income from discontinued operations	1,574	18,966	1,166
Net income	$ 15,770	$ 32,217	$ 10,004
Net income per share – basic:
Continuing operations	$ 0.44	$ 0.41	$ 0.27
Discontinued operations	0.05	0.59	0.04
Net income per share - basic	0.49	1.00	0.31
Net income per share - diluted:
Continuing operations	0.44	0.41	0.27
Discontinued operations	0.05	0.59	0.04
Net income per share - diluted	$ 0.49	$ 1.00	$ 0.31
Weighted average shares of common stock outstanding:
Basic	32,372	32,264	31,861
Diluted	32,428	32,335	32,196
Dividends declared per share		$ 1.00

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 15,770	$ 32,217	$ 10,004
Other comprehensive income, net of taxes:
Unrealized gain on marketable securities	27	15	13
Total other comprehensive income	27	15	13
Comprehensive income	$ 15,797	$ 32,232	$ 10,017

- Definition

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

+ References + Details

Consolidated Statements of Shareholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive (Loss)/Income [Member]
Beginning balance at Dec. 31, 2016	$ 286,108	$ 280,813	$ 5,346	$ (51)
Beginning balance, shares at Dec. 31, 2016		31,748
Cumulative effect of accounting change	2,192		2,192
Net income	10,004		10,004
Comprehensive income	13			13
Stock based compensation	1,852	$ 1,852
Common stock issued under stock plans, net of shares withheld for employee taxes	1	$ 1
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		160
Ending balance at Dec. 31, 2017	300,170	$ 282,666	17,542	(38)
Ending balance, shares at Dec. 31, 2017		31,908
Cumulative effect of accounting change	15,132		15,132
Net income	32,217		32,217
Comprehensive income	15			15
Dividends declared on common stock ($1.00 per share)	(32,518)		(32,518)
Stock based compensation	1,686	$ 1,686
Common stock issued under stock plans, net of shares withheld for employee taxes	2,245	$ 2,245
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		417
Ending balance at Dec. 31, 2018	$ 318,947	$ 286,597	32,373	(23)
Ending balance, shares at Dec. 31, 2018	32,325	32,325
Net income	$ 15,770		15,770
Comprehensive income	27			27
Stock donated to Company (held in treasury), shares		(86)
Stock based compensation	4,244	$ 4,244
Common stock issued under stock plans, net of shares withheld for employee taxes	(820)	$ (820)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		140
Ending balance at Dec. 31, 2019	$ 338,168	$ 290,021	$ 48,143	$ 4
Ending balance, shares at Dec. 31, 2019	32,379	32,379

Consolidated Statements of Shareholders' Equity (Parenthetical)	12 Months Ended
	Dec. 31, 2018 $ / shares
Statement Of Stockholders Equity [Abstract]
Dividends per share common stock	$ 1.00

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
OPERATING ACTIVITIES:
Net income	$ 15,770	$ 32,217	$ 10,004
Income from discontinued operations	(1,574)	(18,966)	(1,166)
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	27,869	24,231	24,047
Stock based compensation	4,244	1,777	1,736
Amortization of deferred commissions	8,305	7,659
Provision for doubtful accounts	211	1,033	1,568
Deferred income taxes	2,167	3,017	(2,144)
(Gain) loss on equity method investments	(64)	(42)	5
Change in fair value of non-marketable equity investments		1,271
Other	(72)	(9)	409
Changes in operating assets and liabilities:
Accounts and unbilled receivables	11,605	(4,050)	1,125
Prepaid royalties	1,698	1,639	2,046
Other prepaid expenses and other current assets	4,862	(3,938)	(25)
Deferred commissions	(9,479)	(11,577)
Other assets	(42)	(30)	(201)
Accounts payable and accrued expenses	1,098	2,008	5,784
Accrued royalties	979	2,907	(32)
Deferred revenue	(1,920)	5,103	(552)
Net cash provided by continuing operating activities	65,657	44,250	42,604
Net cash (used in) provided by discontinued operating activities		(1,004)	4,108
Net cash provided by operating activities	65,657	43,246	46,712
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(27,018)
Proceeds from sale of discontinued operations, net of tax	6,070	44,049
Proceeds from maturities of marketable securities	80,589	68,992	90,073
Purchases of marketable securities	(87,328)	(57,085)	(83,279)
Proceeds from sale of property and equipment	15
Payments to acquire non-marketable equity investments	(3,342)	(833)	(500)
Payments associated with capitalized software development	(14,513)	(11,284)	(9,597)
Purchases of property and equipment	(21,997)	(7,166)	(5,515)
Net cash (used in) provided by continuing investing activities	(67,524)	36,673	(8,818)
Net cash used in discontinued investing activities		(115)	(2,761)
Net cash (used in) provided by investing activities	(67,524)	36,558	(11,579)
FINANCING ACTIVITIES:
Proceeds from exercise of stock options	214	2,582	413
Taxes paid related to net settlement of equity awards	(1,034)	(338)	(412)
Payment of earn-out related to prior acquisitions	(38)	(38)
Payment of debt issue costs		(100)
Payment of cash dividends	(58)	(32,357)
Net cash (used in) provided by financing activities	(916)	(30,251)	1
Net (decrease) increase in cash and cash equivalents	(2,783)	49,553	35,134
Cash and cash equivalents at beginning of period	134,321	84,768	49,634
Cash and cash equivalents at end of period	131,538	134,321	84,768
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid	101	117	101
Income taxes paid	630	16,513	$ 638
Non-cash additions to property and equipment	$ 31	$ 1,013

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity and Segments

HealthStream, Inc. (the Company) was incorporated in 1990 as a Tennessee corporation and is headquartered in Nashville, Tennessee. As of December 31, 2019, the Company operated in two segments: Workforce Solutions and Provider Solutions. Workforce Solutions products help meet the ongoing training, certification, assessment, and development needs of the healthcare workforce; they are delivered via a software-as-a-service (SaaS) model and are sold on a subscription basis. Provider Solutions products offer healthcare organizations software applications for administering and tracking provider credentialing, privileging, call center, and enrollment activities.

On February 12, 2018, the Company divested its Patient Experience (PX) business to Press Ganey Associates (Press Ganey) for $65.2 million in cash (after giving effect to the post-closing working capital adjustment). This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The results of operations for PX are presented as discontinued operations within the Notes to Consolidated Financial Statements herein.

Recently Adopted Accounting Standards

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 Consolidated Balance Sheets and accounting policies for leases but did not have an impact on the Consolidated Statements of Income or Cash Flows. See Note 15 for additional information regarding the new standard and its impact on the Company’s financial statements.

Recognition of Revenue

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 in exchange for transferring those goods or services. The Company adopted ASU 2014-09, Revenue from Contracts with Customer (referred to as Accounting Standards Codification (ASC) Topic 606 or ASC 606) effective as of January 1, 2018 utilizing the modified retrospective approach. This accounting standard required changes to the Company’s accounting policies for revenue recognition, trade and other receivables, and deferred commissions.

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

Subscription 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 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, consulting, 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 services and professional services, the time between billing the customer and when performance obligations are satisfied is generally not significant.

Our contracts with customers often contain promises for multiple goods and services. For these contracts, the Company accounts for the promised goods and services in its contracts as separate performance obligations 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 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.

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Principles of Consolidation

The Consolidated Financial Statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

The Consolidated Financial Statements are prepared in accordance with U.S. generally accepted accounting principles. These accounting principles require management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates and such differences could be material to the Consolidated Financial Statements.

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities

Marketable securities are classified as available for sale and are stated at fair market value, with the unrealized gains and losses, net of tax, reported in other accumulated comprehensive income (loss) on the accompanying Consolidated Balance Sheets. Realized gains and losses and declines in market value judged to be other than temporary on investments in marketable securities are included in other income, net on the accompanying Consolidated Statements of Income. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available for sale are included in other income, net on the accompanying Consolidated Statements of Income. Premiums and discounts are amortized over the life of the related available for sale security as an adjustment to the yield using the effective interest method.

Deferred Commissions

Deferred commissions represent incremental costs to acquire contracts with customers, such as the initial sales commission payment, which are capitalized and amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit. Capitalized contract costs are included under the caption deferred commissions in the accompanying Consolidated Balance Sheet. 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 contract term or technological obsolescence period of three years.

Prepaid Royalties

Prepaid royalties represent advance payments to royalty partners under revenue sharing arrangements for which the Company sells and delivers such partner products to its customers. Royalties are typically paid in advance at the commencement of the subscription period or periodically throughout the subscription period, such as in quarterly, bi-annual, or annual installments. Royalty payments are amortized over the term of the underlying subscription contracts, which generally range from one to five years, in order to match the direct royalty costs to the same period the subscription revenue is recognized. Amortization of royalties is included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

Allowance for Doubtful Accounts

The Company estimates its allowance for doubtful accounts to include accounts that may become uncollectible in the future, along with using a specific identification method in which management considers the facts and circumstances surrounding each potentially uncollectible receivable. Uncollectible receivables are written-off in the period management believes it has exhausted its ability to collect payment from the customer. Bad debt expense is recorded when events or circumstances indicate an additional allowance is required.

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):

	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2019	$	1,161	$	211	$	(529	)	$	843
2018		1,979		1,033		(1,851	)		1,161
2017		839		1,568		(428	)		1,979

Capitalized Software Development

Capitalized software development is stated on the basis of cost and is presented net of accumulated amortization. The Company capitalizes costs incurred during the software development phase for projects when such costs are material. These assets are generally amortized using the straight-line method over three years. The Company capitalized $14.1 million and $11.9 million during 2019 and 2018, respectively. Amortization of capitalized software development was $11.0 million, $9.6 million, and $8.9 million during 2019, 2018, and 2017, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2019 and 2018, there were no capitalized software development costs for external computer software developed for resale.

Fair Value Measurements

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy prioritizes the inputs to valuation techniques used in measuring fair value. There are three levels to the fair value hierarchy based on the reliability of inputs, as follows:

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

The Company evaluates assets and liabilities subject to fair value measurements on a recurring basis to determine the appropriate level at which to classify them for each reporting period. This determination requires significant judgments to be made by the Company. At December 31, 2019 and 2018, our assets measured at fair value on a recurring basis consisted of marketable securities, which are classified as available for sale (see Note 4 – Marketable Securities).

Property and Equipment

Property and equipment are stated on the basis of cost. Depreciation is provided on the straight-line method over the following estimated useful lives, except for assets under financing leases and leasehold improvements, which are amortized over the shorter of the estimated useful life or their respective lease term.

	Years
Furniture and fixtures	5 - 7
Equipment		3

Goodwill and Intangible Assets

Goodwill represents the excess of purchase price in a business combination over the fair value of the net identifiable assets acquired, including intangible assets. The Company estimates fair values of intangible assets using the income and cost methods, which are based on management’s estimates and assumptions. The carrying amount of our goodwill is evaluated for impairment at least annually during the fourth quarter and whenever events or changes in facts or circumstances indicate that impairment may exist. In accordance with ASC 350, Intangibles – Goodwill and Other, companies may opt to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. A qualitative assessment includes factors such as financial performance, industry and market metrics, and other factors affecting the reporting unit. If this assessment concludes that it is more likely than not that the fair value of a reporting unit exceeds its carrying value, then goodwill is not considered impaired and no further impairment testing is required. Conversely, if the qualitative assessment concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying value, we must then compare the fair value of the reporting unit to its carrying value. The Company determines fair value of the reporting units using both income and market-based models. These models require the use of various assumptions relating to cash flow projections, growth rates, discount rates, and terminal value calculations. There were no goodwill impairments identified or recorded for the years ended December 31, 2019, 2018, or 2017.

As of December 31, 2019, intangible assets include customer relationships, internally developed technology, non-competition agreements, and trade names. These intangible assets are considered to have definite useful lives and are being amortized on a straight-line basis over periods ranging between three and thirteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2019 was 11.0 years. Intangible assets are reviewed for impairment whenever events or changes in facts or circumstances indicate that the carrying amount of the assets may not be recoverable. There were no intangible asset impairments identified or recorded for the years ended December 31, 2019, 2018, or 2017.

Long-Lived Assets

Long-lived assets to be held for use are reviewed for events or changes in facts and circumstances, both internally and externally, which may indicate that an impairment of long-lived assets held for use is present. The Company measures any impairment using observable market values or discounted future cash flows from the related long-lived assets. The cash flow estimates and discount rates incorporate management’s best estimates, using appropriate and customary assumptions and projections at the date of evaluation. Management periodically evaluates whether the carrying value of long-lived assets, including intangible assets, property and equipment, capitalized software development, deferred commissions, and other assets will be recoverable. There were no long-lived asset impairments identified or recorded for the years ended December 31, 2019, 2018, or 2017.

Non-Marketable Equity Investments

Non-marketable equity investments are accounted for using the equity method when the Company can exercise significant influence over the investee. Investments for which the Company is not able to exercise significant influence over the investee are accounted for using the measurement alternative for equity investments that do not have readily determinable fair values. 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 fair value of non-marketable equity 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. The proportionate share of income or loss from equity method investments and any changes in fair value of investments accounted for using the measurement alternative are recorded under the caption other income, net in the accompanying Consolidated Statements of Income.

Financial Instruments

The Company has various financial instruments, including cash and cash equivalents, accounts receivable, accounts receivable-unbilled, accounts payable, accrued liabilities, and deferred revenue. The carrying amounts of these financial instruments approximate fair value because of the short-term maturity or short-term nature of such instruments. The Company also has marketable securities, which are recorded at approximate fair value based on quoted market prices or alternative pricing sources (see Note 4 – Marketable Securities).

Advertising

The Company expenses the costs of advertising as incurred. Advertising expense for the years ended December 31, 2019, 2018, and 2017 was $765,000, $721,000, and $868,000, respectively, and is included under the caption sales and marketing expense in the accompanying Consolidated Statements of Income.

Shipping and Handling Costs

Shipping and handling costs that are associated with our products and services are included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

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. Management evaluates all available evidence, both positive and negative, to determine whether, based on the weight of that evidence, a valuation allowance is needed. Future realization of the tax benefit of an existing deductible temporary difference or carryforward ultimately depends on the existence of sufficient taxable income of the appropriate character within the carryback or carryforward period available under the tax law. There are four possible sources of taxable income that may be available under the tax law to realize a tax benefit for deductible temporary differences and carryforwards: 1) future reversals of existing taxable temporary differences, 2) future taxable income exclusive of reversing temporary differences and carryforwards, 3) taxable income in prior carryback year(s) if carryback is permitted under the tax law, and 4) tax-planning strategies that would, if necessary, be implemented to realize deductible temporary differences or carryforwards prior to their expiration. Management reviews the realizability of its deferred tax assets each reporting period to identify whether any significant changes in circumstances or assumptions have occurred that could materially affect the realizability of deferred tax assets. As of December 31, 2019, the Company had established a valuation allowance of $64,000 for the portion of its net deferred tax assets that are not more likely than not expected to be realized. The Company accounts for income tax uncertainties using a more-likely-than-not recognition threshold based on the technical merits of the tax position taken. Tax positions that meet the more-likely-than-not recognition threshold are measured in order to determine the tax benefit to be recognized in the financial statements.

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 for the period by the weighted average number of 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 restricted share units subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. Common equivalent shares that have an anti-dilutive effect on diluted net income per share were excluded from the calculation of diluted weighted average shares outstanding for the years ended December 31, 2019, 2018, and 2017.

Concentrations of Credit Risk and Significant Customers

The Company’s credit risks relate primarily to cash and cash equivalents, marketable securities, and accounts receivable. The Company places its temporary excess cash investments in high quality, short-term money market instruments. At times, such investments may be in excess of the FDIC insurance limits. Marketable securities consist primarily of investment grade corporate debt securities and government sponsored enterprise debt securities.

The Company sells its products and services to various companies in the healthcare industry that are primarily located in the United States. Customer credit worthiness evaluations are performed on an as-needed basis, and the Company generally requires no collateral from customers. An allowance for doubtful accounts is maintained for potentially uncollectible accounts receivable. The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2019, 2018, or 2017.

Stock Based Compensation

As of December 31, 2019, the Company maintained two stock based compensation plans under which awards are outstanding, as described in Note 11. The Company accounts for stock based compensation using the fair-value based method for costs related to share-based payments, including stock options and restricted share units. The Company uses the Black Scholes option pricing model for calculating the fair value of option awards issued under its stock based compensation plan. The Company measures compensation cost of restricted share units based on the closing fair market value of the Company’s stock on the date of grant. Stock based compensation cost is measured at the grant date, based on the fair value of the award that is ultimately expected to vest, and is recognized as an expense over the requisite service period. The Company recognizes tax benefits from stock based compensation if an excess tax benefit is realized. Excess tax benefits are reflected in the Consolidated Statements of Income as a component of the provision for income taxes when realized.

Recently Issued Accounting Pronouncements 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 Company adopted this ASU on January 1, 2020 and the effect of adoption on the Company’s consolidated financial statements and related disclosures is not expected to be material.

Shareholders' Equity

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

Shareholders' Equity

2. SHAREHOLDERS’ EQUITY

Common Stock

The Company is authorized to issue up to 75 million shares of common stock. The number of common shares issued and outstanding as of December 31, 2019 and 2018 was 32.4 million and 32.3 million, respectively.

Preferred Stock

The Company is authorized to issue up to 10 million shares of preferred stock in one or more series, having the relative voting powers, designations, preferences, rights and qualifications, limitations or restrictions, and other terms as the Board of Directors may fix in providing for the issuance of such series, without any vote or action of the shareholders.

Earnings Per Share

12 Months Ended

Dec. 31, 2019

Earnings Per Share [Abstract]

Earnings Per Share

3. EARNINGS PER SHARE

The following table sets forth the computation of basic and diluted earnings per share for the three years ended December 31, 2019 (in thousands, except per share amounts):

	Year Ended December 31,
	2019		2018		2017
Numerator:
Income from continuing operations	$	14,196	$	13,251	$	8,838
Income from discontinued operations		1,574		18,966		1,166
Net income	$	15,770	$	32,217	$	10,004
Denominator:
Weighted-average shares outstanding		32,372		32,264		31,861
Effect of dilutive shares		56		71		335
Weighted-average diluted shares		32,428		32,335		32,196

Earnings per share – basic:
Continuing operations	$	0.44	$	0.41	$	0.27
Discontinued operations		0.05		0.59		0.04
Earnings per share - basic	$	0.49	$	1.00	$	0.31

Earnings per share – diluted:
Continuing operations	$	0.44	$	0.41	$	0.27
Discontinued operations		0.05		0.59		0.04
Earnings per share - diluted	$	0.49	$	1.00	$	0.31

Potentially dilutive shares representing 93,000, 91,000, and 58,000 shares of common stock for the years ended December 31, 2019, 2018, and 2017, respectively, were excluded from the calculation of diluted earnings per share because their effect would have been anti-dilutive.

Marketable Securities

12 Months Ended

Dec. 31, 2019

Investments Debt And Equity Securities [Abstract]

Marketable Securities

4. MARKETABLE SECURITIES

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

	December 31, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	37,325	$	7	$	(5	)	$	37,327
Government-sponsored enterprise debt securities		4,001		—		—			4,001
Total	$	41,326	$	7	$	(5	)	$	41,328

	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 of the marketable securities reported in the Consolidated Balance Sheets approximate fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of December 31, 2019, the Company does not consider any of its marketable securities to be other than temporarily impaired. During the years ended December 31, 2019 and 2018, the Company did not reclassify any items out of accumulated other comprehensive income to net income. All investments in marketable securities are classified as a current asset on the Consolidated Balance Sheet because the underlying securities mature within one year from the balance sheet date.

Revenue Recognition and Sales Commissions

12 Months Ended

Dec. 31, 2019

Revenue From Contract With Customer [Abstract]

Revenue Recognition and Sales Commissions

5. REVENUE RECOGNITION AND SALES COMMISSIONS

Revenue Recognition

The following table represents revenues included in continuing operations disaggregated by revenue source for the years ended December 31, 2019 and 2018 (in thousands). Sales taxes are excluded from revenues.

	Year Ended December 31, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

	Year Ended December 31, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	184,926	$	35,542	$	220,468
Professional services		5,213		5,935		11,148
Total revenues, net	$	190,139	$	41,477	$	231,616

For the years ended December 31, 2019 and 2018, the Company recognized $0.2 million and $1.0 million, respectively, in impairment losses on receivables and contract assets arising from the Company’s contracts with customers.

During the years ended December 31, 2019 and 2018, we recognized revenues of $64.7 million and $63.7 million from amounts included in deferred revenue at the beginning of the respective period. As of December 31, 2019, $433 million of revenue is expected to be recognized from remaining performance obligations under contracts with customers. We expect to recognize revenue on approximately 47% of these remaining performance obligations over the 12 months ending December 31, 2020, 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 included multiple payments, including an initial payment 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 service condition of the employee are expensed ratably through the payment date. The capitalized contract cost is included in deferred commissions in the accompanying Consolidated Balance Sheets. The Company recorded amortization of deferred commissions of $8.3 million and $7.7 million for

the years ended December 31, 2019 and 2018, which is included in sales and marketing expenses in the accompanying Consolidated Statements of Income.

Property and Equipment

12 Months Ended

Dec. 31, 2019

Property Plant And Equipment [Abstract]

Property and Equipment

6. PROPERTY AND EQUIPMENT

Property and equipment consist of the following (in thousands):

	December 31,
	2019			2018
Equipment	$	25,199		$	21,129
Leasehold improvements		14,909			11,572
Furniture and fixtures		5,248			3,992
Gross property and equipment		45,356			36,693
Accumulated depreciation and amortization		(19,291	)		(20,827	)
Property and equipment, net	$	26,065		$	15,866

Depreciation of property and equipment totaled $7.3 million, $5.5 million, and $5.9 million for the years ended December 31, 2019, 2018, and 2017, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2019

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

7. GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2019 and 2018 are as follows (in thousands):

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2019	$	16,381	$	69,763	$	86,144
Acquisition of Providigm, LLC		11,395		—		11,395
Acquisition of CredentialMyDoc		—		4,657		4,657
Balance at December 31, 2019	$	27,776	$	74,420	$	102,196

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2018	$	16,381	$	69,763	$	86,144
Changes in carrying amount		—		—		—
Balance at December 31, 2018	$	16,381	$	69,763	$	86,144

During the year ended December 31, 2019, the Company recorded $11.4 million of goodwill in relation to the January 2019 acquisition of Providigm, LLC as well as $4.7 million of goodwill in relation to the December 2019 acquisition of CredentialMyDoc.

Intangible assets other than goodwill are considered to have finite useful lives. Customer-related intangibles consist of customer relationships and are amortized over their estimated useful lives ranging from five to thirteen years. Other intangible assets include technology, non-competition agreements, and trade names and are amortized over their estimated useful lives ranging from three to nine years. Amortization of intangible assets was $9.6 million, $9.1 million, and $9.2 million for the years ended December 31, 2019, 2018, and 2017, respectively.

Identifiable intangible assets are comprised of the following (in thousands):

	As of December 31, 2019							As of December 31, 2018
	Gross Amount		Accumulated Amortization			Net		Gross Amount		Accumulated Amortization			Net
Customer related	$	82,314	$	(29,760	)	$	52,554	$	76,714	$	(23,245	)	$	53,469
Other		20,262		(12,735	)		7,527		15,572		(9,663	)		5,909
Total	$	102,576	$	(42,495	)	$	60,081	$	92,286	$	(32,908	)	$	59,378

The expected future annual amortization expense for the years ending December 31, is as follows (in thousands):

2020	$	9,683
2021		8,914
2022		7,835
2023		7,186
2024		5,679
Thereafter		20,784
Total	$	60,081

Business Combinations

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Business Combinations

8. BUSINESS COMBINATIONS

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 2019 and $325,000 was incurred during 2018. The transaction costs were recorded in other general and administrative expense in the Consolidated Statements of Income. The results of operations for Providigm have been included in the 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 (including the post-closing working capital adjustment)	$	14,368
Cash held in escrow		3,650
Total consideration paid	$	18,018

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

Accounts and unbilled receivable, net	$	960
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,395
Intangible assets		5,950
Accounts payable and accrued liabilities		(1,196	)
Deferred revenue		(141	)
Operating lease liabilities		(1,233	)
Net assets acquired	$	18,018

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, and EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. 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 provides that the Company will pay 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 these financial performance targets, which has been included in the 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):

	Fair Value		Useful life
Customer relationships	$	3,500	12 years
Developed technology		2,200	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	5,950

The amounts of revenue and operating loss of Providigm included in the Company’s Consolidated Statement of Income since the date of acquisition of January 10, 2019 for the twelve months ended December 31, 2019 are as follows (in thousands):

Revenues, net		$	6,916
Operating loss		$	(491	)

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

	For the twelve months ended
	2019		2018
Total revenues	$	254,437	$	243,992
Income from continuing operations	$	14,262	$	13,102
Net income	$	15,836	$	32,068
Net income per share - basic	$	0.49	$	0.99
Net income per share - diluted	$	0.49	$	0.99

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 are 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.

CredentialMyDoc

On December 16, 2019, the Company acquired substantially all the assets of CredentialMyDoc, a Savannah, Georgia based company focusing on intuitive, easy to use, and fast to implement software-as-a-service solution, especially in ambulatory care settings. The consideration paid for CredentialMyDoc consisted of $9.0 million in cash, subject to a post-closing working capital adjustment. Of the purchase price paid at closing, $1.1 million is being held in escrow for a period of time following the closing to serve as a source of recovery for the working capital adjustment and certain potential indemnification claims by the Company. The results of operations for CredentialMyDoc have been included in the Provider 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	$	7,920
Cash held in escrow		1,080
Total consideration paid	$	9,000

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	$	216
Prepaid and other current assets		3
Operating lease right-of-use assets		30
Deferred tax assets		71
Goodwill		4,657
Intangible assets		4,340
Accounts payable and accrued liabilities		(7	)
Deferred revenue		(280	)
Operating lease liabilities		(30	)
Net assets acquired	$	9,000

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. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, and EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. 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. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering CredentialMyDoc products, and expected synergies from integrating CredentialMyDoc 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 $595,000 to an estimated fair value of $280,000. The $315,000 write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

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	$	2,100	9 years
Developed technology		2,100	4 years
Non-compete		110	5 years
Trade name		30	3 years
Total intangible assets subject to amortization	$	4,340

The amounts of revenue and operating loss of CredentialMyDoc included in the Company’s Consolidated Statement of Income since the date of acquisition of December 16, 2019 for the twelve months ended December 31, 2019 are as follows (in thousands):

Total revenues		$	34
Operating loss		$	(49	)

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

	Year Ended December 31,
	2019		2018
Total revenues	$	256,053	$	236,445
Income from continuing operations	$	13,936	$	12,687
Net income	$	15,510	$	31,652
Net income per share - basic	$	0.48	$	0.98
Net income per share - diluted	$	0.48	$	0.98

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, 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.

Business Segments

12 Months Ended

Dec. 31, 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 (Workforce Solutions) and provider credentialing, privileging, call center, and enrollment products and services (Provider Solutions).

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, gains and losses from equity investments, 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 as of and for the years ended December 31, 2019, 2018, and 2017 (in thousands).

Revenues, net:	2019			2018			2017
Workforce Solutions	$	208,599		$	190,139		$	178,061
Provider Solutions		45,513			41,477			36,838
Total revenues, net	$	254,112		$	231,616		$	214,899

Operating income:	2019			2018			2017
Workforce Solutions	$	40,296		$	38,834		$	33,579
Provider Solutions		5,384			3,474			879
Unallocated		(30,960	)		(26,817	)		(25,051	)
Total operating income	$	14,720		$	15,491		$	9,407

	Assets*				Purchases of long-lived assets						Depreciation and amortization
	2019		2018		2019		2018		2017		2019		2018		2017
Workforce Solutions	$	118,382	$	104,668	$	14,972	$	12,820	$	9,888	$	10,813	$	9,780	$	9,982
Provider Solutions		148,398		145,637		2,959		5,240		3,619		9,757		8,895		8,147
Discontinued operations		—		—		—		180		2,764		—		181		2,235
Unallocated		222,764		191,643		13,602		7,191		1,762		7,299		5,375		5,919
Total	$	489,544	$	441,948	$	31,533	$	25,431	$	18,033	$	27,869	$	24,231	$	26,283

* Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not allocated to individual segments and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Income Taxes

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

10. INCOME TAXES

The provision (benefit) for income taxes is comprised of the following (in thousands):

	Year Ended December 31,
	2019		2018			2017
Current federal	$	233	$	(79	)	$	1,819
Current state		634		386			923
Deferred federal		2,717		2,661			(1,464	)
Deferred state		149		356			24
Provision for income taxes	$	3,733	$	3,324		$	1,302

A reconciliation of income taxes at the statutory federal income tax rate to the provision for income taxes included in the accompanying Consolidated Statements of Income is as follows (in thousands):

	Year Ended December 31,
	2019			2018			2017
Federal tax provision at the statutory rate	$	3,765		$	3,482		$	3,549
State income tax provision, net of federal benefit		895			658			491
Tax credits		(614	)		(509	)		(583	)
Change in state valuation allowance		(247	)		2			151
Tax Act revaluation of deferred tax balances		—			—			(1,680	)
Stock compensation		(117	)		(560	)		(626	)
Other		51			251			—
Provision for income taxes	$	3,733		$	3,324		$	1,302

Management periodically assesses the realizability of its deferred tax assets, and to the extent that a recovery is not likely, a valuation allowance is established to reduce the deferred tax asset to the amount estimated to be recoverable. At December 31, 2019, the Company has a valuation allowance of $64,000 recorded against deferred tax assets for state net operating losses.

As of December 31, 2019, the Company had state net operating loss carryforwards of $5.0 million. Certain losses have an indefinite carryforward period, while other loss carryforwards will expire in years 2031 through 2040. The Company is subject to income taxation at the federal and various state levels. The Company is no longer subject to U.S. federal tax examinations for tax years before 2016, and with few exceptions, the Company is not subject to examination by state tax authorities for tax years which ended before 2016. Loss carryforwards and credit carryforwards generated or utilized in years earlier than 2016 are also subject to examination and adjustment.

On December 22, 2017, the President signed into law the Tax Cuts and Jobs Act (the Tax Act), reducing the U.S. corporate income tax rate to 21% effective January 1, 2018. The Company reflected the income tax effects of the Tax Act as of December 31, 2017.

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits are as follows (in thousands):

	December 31,
	2019		2018
Balance at beginning of year	$	317	$	340
Additions for tax positions in the current year		—		—
Reductions for tax positions of prior years		—		(23	)
Balance at end of year	$	317	$	317

The Company recognized $14,000 and $2,000 for interest and penalties related to unrecognized tax benefits within the provision for income taxes during the years ended December 31, 2019 and 2018. Unrecognized tax benefits included tax positions of $317,000 for both December 31, 2019 and 2018 that if recognized would impact the Company’s effective tax rate. The reduction for tax positions of prior years reflected in the table above as of December 31, 2018 relates to an item considered to be effectively settled due to lapse of the statute of limitations.

Deferred federal and state income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of deferred tax assets and deferred tax liabilities are as follows (in thousands):

	December 31,
	2019			2018
Deferred tax assets:
Allowance for doubtful accounts	$	215		$	297
Accrued liabilities		1,775			1,887
Lease liability		8,778			389
Stock based compensation		683			623
Deferred revenue		198			135
Basis difference on investments		381			396
Net operating loss carryforwards		263			291
Total deferred tax assets		12,293			4,018
Less: Valuation allowance		(64	)		(311	)
Deferred tax assets, net of valuation allowance		12,229			3,707
Deferred tax liabilities:
Deductible goodwill		2,236			1,760
Nondeductible intangible assets		801			1,049
Right of use assets		7,773			—
Prepaid assets		6,275			5,698
Capitalized software development		5,580			4,746
Depreciation		2,478			659
PX sale deferral		—			718
Total deferred tax liabilities		25,143			14,630

Net deferred tax liabilities	$	12,914		$	10,923

The Company realized $117,000 of excess tax benefits related to stock based awards during the year ended December 31, 2019, which was reflected in the statement of income as a component of the provision for income taxes.

Stock Based Compensation

12 Months Ended

Dec. 31, 2019

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock Based Compensation

11. STOCK BASED COMPENSATION

Stock Incentive Plans

The Company has outstanding stock based awards under its 2016 Omnibus Incentive Plan (2016 Plan) and 2010 Stock Incentive Plan (2010 Plan) (collectively, the 2016 Plan and the 2010 Plan, referred to as the Plans). In addition, the 2016 Plan authorizes the grant of options, restricted share units (RSUs), or other forms of stock based compensation to employees, officers, directors, and others, and such grants must be approved by the Compensation Committee of the Board of Directors. The 2016 Plan allows the Compensation Committee of the Board of Directors to determine the vesting period and parameters of each grant. The vesting period of the options and RSUs granted has historically ranged from immediate vesting to annual vesting up to four years, generally beginning one year after the grant date. As of December 31, 2019, 867,000 shares of unissued common stock remained reserved for future stock incentive grants under the 2016 Plan. The Company issues new shares of common stock when options are exercised or when RSUs become vested.

Stock Option Activity

A summary of activity and various other information relative to stock options for the year ended December 31, 2019 is presented in the tables below (in thousands, except exercise price).

				Weighted-
	Common			Average		Aggregate
	Shares			Exercise Price		Intrinsic Value
Outstanding at beginning of period		19		$	11.27
Granted		—			—
Exercised		(19	)		11.27
Expired		—			—
Forfeited		—			—
Outstanding at end of period		—		$	—	$	—
Exercisable at end of period		—		$	—	$	—

Other information relative to option activity during the three years ended December 31, 2019 is as follows (in thousands):

	2019		2018		2017
Total intrinsic value of stock options exercised	$	277	$	6,130	$	1,973
Cash proceeds from exercise of stock options	$	214	$	2,582	$	413

Restricted Share Unit Activity

A summary of activity relative to RSUs for the year ended December 31, 2019 is as follows (in thousands, except weighted average grant date fair value):

				Weighted-
	Number of			Average Grant Date		Aggregate
	RSU’s			Fair Value		Intrinsic Value
Outstanding at beginning of period		289		$	24.31
Granted		100			27.24
Vested		(82	)		23.29
Forfeited		(19	)		24.38
Outstanding at end of period		288		$	25.61	$	7,847

The aggregate intrinsic value for stock options represents the total difference between the Company’s closing stock price on December 30, 2019 (the last trading day of the year) of $27.22 per share and the grant date fair value, multiplied by the number of unvested RSUs as of December 31, 2019.

The aggregate fair value of RSUs that vested during the year ended December 31, 2019 and 2018, as of the respective vesting dates, was $1.9 million and $1.8 million, respectively. A portion of RSUs that vested in 2019 and 2018 were net-share settled such that the Company withheld shares with value equivalent to the employees’ minimum statutory obligation for the applicable income and other employment taxes and remitted the cash to the appropriate taxing authorities. The total shares withheld for RSUs during 2019 and 2018 were 15,000 and 13,000, respectively, and were based on the value of the RSUs on their respective settlement dates as determined by the Company’s closing stock price. Total payments related to RSUs for the employees’ tax obligations to taxing authorities were $0.4 million in 2019, $0.3 million in 2018, and $0.4 million in 2017, and are reflected as a financing activity within the Consolidated Statements of Cash Flows. These net-share settlements had the effect of share repurchases by the Company as they reduced and retired the number of shares that would have otherwise been issued as a result of the vesting and did not represent an expense to the Company.

Stock Based Compensation

Total stock based compensation expense, which is recorded in our Consolidated Statements of Income, recorded for the years ended December 31, is as follows (in thousands):

	Years Ended December 31,
	2019		2018		2017
Cost of revenues (excluding depreciation and amortization)	$	699	$	37	$	29
Product development		956		296		228
Sales and marketing		614		183		244
Other general and administrative		1,975		1,261		1,235
Total stock based compensation expense	$	4,244	$	1,777	$	1,736

The Company amortizes the fair value of all stock based awards, net of estimated forfeitures, on a straight-line basis over the requisite service period, which generally is the vesting period. As of December 31, 2019, total unrecognized compensation expense related to non-vested stock options and RSUs was $3.5 million, net of estimated forfeitures, with a weighted average expense recognition period remaining of 2.4 years. The Company realized $117,000 of excess tax benefits related to stock based awards during the year ended December 31, 2019, which was reflected in the Consolidated Statement of Income as a component of the provision for income taxes.

Stock based compensation cost for RSUs is measured based on the closing fair market value of the Company’s stock on the date of grant. Stock based compensation cost for stock options is estimated at the grant date based on the fair value calculated using the Black-Scholes method. The Company did not grant any stock options during the years ended December 31, 2019, 2018, or 2017.

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 $0.6 million and are reflected as a financing activity within the Consolidated Statement of Cash Flows for 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).

Employee Benefit Plan

12 Months Ended

Dec. 31, 2019

Compensation And Retirement Disclosure [Abstract]

Employee Benefit Plan

12. EMPLOYEE BENEFIT PLAN

401(k) Plan

The Company has a defined-contribution employee benefit plan (401(k) Plan) incorporating provisions of Section 401(k) of the Internal Revenue Code. Employees must have attained the age of 21 and have completed thirty days of service to be eligible to participate in the 401(k) Plan. Under the provisions of the 401(k) Plan, a plan member may make contributions, on a tax-deferred basis, subject to IRS limitations. The Company elected to provide eligible employees with matching contributions totaling $1.4 million, $1.3 million, and $0.7 million for the years ended December 31, 2019, 2018, and 2017, respectively.

Discontinued Operations

12 Months Ended

Dec. 31, 2019

Discontinued Operations And Disposal Groups [Abstract]

Discontinued Operations

13. DISCONTINUED OPERATIONS

On February 12, 2018, the Company divested its PX business 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 $20.5 million, of which $19.0 million was recorded during the year ended December 31, 2018 and $1.5 million was recorded during the year ended December 31, 2019.

This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The Company has classified the results of its PX business segment as discontinued operations in its 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 years ended December 31, 2018 and 2017 are presented in discontinued operations in the Company’s Consolidated Statements of Income. The following table presents the financial results of the PX business (in thousands):

	Year Ended December 31,
	2018			2017
Revenues, net	$	3,342		$	32,763
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		1,982			18,792
Product development		554			3,751
Sales and marketing		460			4,310
Other general and administrative expenses		229			3,282
Depreciation and amortization		181			2,235
Total operating costs and expenses		3,406			32,370

Operating (loss) income		(64	)		393

Other income		—			—

(Loss) income from discontinued operations before income tax provision		(64	)		393
Income tax benefit		—			(773	)
(Loss) income from discontinued operations, net of income taxes	$	(64	)	$	1,166

Debt

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Debt

14. DEBT

At December 31, 2019 and 2018, the Company had no debt outstanding.

Revolving Credit Facility

The Company entered into a Second Amendment to Revolving Credit Agreement (Revolving Credit Facility), amending the Revolving Credit Facility, dated as of December 31, 2018 with SunTrust Bank (SunTrust), extending 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 Loan Agreement), 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 December 31, 2019, the Company was in compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of December 31, 2019 and there were no borrowings under the Revolving Credit Facility during the year ended December 31, 2019.

Leases

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Leases

15. 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 allowing companies to not reassess: (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 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 operating leases as part of its acquisitions of Providigm, resulting in a $1.2 million ROU asset and lease liability, and CredentialMyDoc, resulting in a $30,000 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 December 31, 2019, the Company had one lease that had not yet commenced that will add $85,000 to ROU asset and lease liability upon commencement on January 1, 2020.

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 Consolidated Statement of Income was $4.9 million for the twelve months ended December 31, 2019. Cash paid for amounts included in the measurement of operating lease liabilities was $2.5 million for the year ended December 31, 2019. As of December 31, 2019, the weighted-average remaining lease term was 10.6 years, and the weighted-average incremental borrowing rate was 6%.

The table below presents the lease-related assets and liabilities recorded on the Consolidated Balance Sheet as of December 31, 2019 (in thousands).

Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	29,615
Total leased assets		$	29,615
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,797
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		30,733
Total operating lease liabilities		$	33,530

The table below presents the maturities of lease liabilities under non-cancellable leases as of December 31, 2019 (in thousands).

2020	$	4,749
2021		4,591
2022		4,124
2023		3,979
Thereafter		28,655
Total undiscounted lease payments	$	46,098
Less imputed interest		12,568
Total lease liabilities	$	33,530

Collaborative Arrangement

12 Months Ended

Dec. 31, 2019

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Collaborative Arrangement

16. COLLABORATIVE ARRANGEMENT

The Company participated in a collaborative arrangement, SimVentures^TM, with Laerdal Medical A/S (Laerdal Medical), which ended effective March 1, 2018. Prior to the termination of this collaborative arrangement, the Company received 50 percent of the profits or losses generated from the collaborative arrangement. For the year ended December 31, 2018, the Company recorded $391,000 of revenues and $187,000 of expenses related to the collaborative arrangement. For the year ended December 31, 2017, the Company recorded $2.2 million of revenues and $1.2 million of expenses related to the collaborative arrangement.

Litigation

12 Months Ended

Dec. 31, 2018

Commitments And Contingencies Disclosure [Abstract]

Litigation

17. LITIGATION

In connection with its business, the Company is from time to time involved in various legal actions. The litigation process is inherently uncertain, and it is possible that the resolution of such matters might have a material adverse effect upon the financial condition and/or results of operations of the Company. However, in the opinion of the Company’s management, matters currently pending or threatened against the Company are not expected to have a material adverse effect on the financial position or results of operations of the Company.

Non-Marketable Equity Investments

12 Months Ended

Dec. 31, 2019

Investments Debt And Equity Securities [Abstract]

Non-Marketable Equity Investments

18. NON-MARKETABLE EQUITY INVESTMENTS

Non-marketable equity investments where the Company is not able to exercise significant influence over the investee are accounted for using the measurement alternative for equity investments that do not have readily determinable fair values. 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 non-marketable equity investments was $5.4 million and $2.1 million for the years ended December 31, 2019 and 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 non-marketable equity 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 non-marketable equity 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.

Subsequent Event

12 Months Ended

Dec. 31, 2019

Subsequent Events [Abstract]

Subsequent Events

19. SUBSEQUENT EVENT

In June 2018, a contract with one of our royalty partners expired and was not renewed. However, the contract required continued royalty payments for any subscriptions that extended beyond the contract termination date. Following the contract termination, there was a mutual disagreement related to various elements of this past partnership, and the Company accrued but did not pay royalties to the partner following the contract expiration. During the first quarter of 2020, the Company received a release of liability from the partner associated with this contract, resulting in no royalties to be paid to the partner. The de-recognition of this liability will be recorded as a $3.4 million reduction to cost of goods sold in the first quarter of 2020.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Reporting Entity and Segments

Recently Adopted Accounting Standards

Recognition of Revenue

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

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Principles of Consolidation

The Consolidated Financial Statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities

Deferred Commissions

Prepaid Royalties

Allowance for Doubtful Accounts

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):

	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2019	$	1,161	$	211	$	(529	)	$	843
2018		1,979		1,033		(1,851	)		1,161
2017		839		1,568		(428	)		1,979

Capitalized Software Development

Fair Value Measurements

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

Property and Equipment

	Years
Furniture and fixtures	5 - 7
Equipment		3

Goodwill and Intangible Assets

Long-Lived Assets

Non-Marketable Equity Investments

Financial Instruments

Advertising

Shipping and Handling Costs

Income Taxes

Earnings Per Share

Earnings per Share

Concentrations of Credit Risk and Significant Customers

Stock Based Compensation

Recently Issued Accounting Pronouncements Not Yet Adopted

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):

	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2019	$	1,161	$	211	$	(529	)	$	843
2018		1,979		1,033		(1,851	)		1,161
2017		839		1,568		(428	)		1,979

Estimated Useful Lives of Property and Equipment

	Years
Furniture and fixtures	5 - 7
Equipment		3

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 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 years ended December 31, 2019 (in thousands, except per share amounts):

	Year Ended December 31,
	2019		2018		2017
Numerator:
Income from continuing operations	$	14,196	$	13,251	$	8,838
Income from discontinued operations		1,574		18,966		1,166
Net income	$	15,770	$	32,217	$	10,004
Denominator:
Weighted-average shares outstanding		32,372		32,264		31,861
Effect of dilutive shares		56		71		335
Weighted-average diluted shares		32,428		32,335		32,196

Earnings per share – basic:
Continuing operations	$	0.44	$	0.41	$	0.27
Discontinued operations		0.05		0.59		0.04
Earnings per share - basic	$	0.49	$	1.00	$	0.31

Earnings per share – diluted:
Continuing operations	$	0.44	$	0.41	$	0.27
Discontinued operations		0.05		0.59		0.04
Earnings per share - diluted	$	0.49	$	1.00	$	0.31

Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2019

Investments Debt And Equity Securities [Abstract]

Fair Value of Available for Sale Marketable Securities

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

	December 31, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	37,325	$	7	$	(5	)	$	37,327
Government-sponsored enterprise debt securities		4,001		—		—			4,001
Total	$	41,326	$	7	$	(5	)	$	41,328

	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

Revenue Recognition and Sales Commissions (Tables)

12 Months Ended

Dec. 31, 2019

Revenue From Contract With Customer [Abstract]

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

	Year Ended December 31, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

	Year Ended December 31, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	184,926	$	35,542	$	220,468
Professional services		5,213		5,935		11,148
Total revenues, net	$	190,139	$	41,477	$	231,616

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2019

Property Plant And Equipment [Abstract]

Summary of Property and Equipment

Property and equipment consist of the following (in thousands):

	December 31,
	2019			2018
Equipment	$	25,199		$	21,129
Leasehold improvements		14,909			11,572
Furniture and fixtures		5,248			3,992
Gross property and equipment		45,356			36,693
Accumulated depreciation and amortization		(19,291	)		(20,827	)
Property and equipment, net	$	26,065		$	15,866

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill And Intangible Assets Disclosure [Abstract]

Changes in Carrying Amount of Goodwill

The changes in the carrying amount of goodwill for the years ended December 31, 2019 and 2018 are as follows (in thousands):

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2019	$	16,381	$	69,763	$	86,144
Acquisition of Providigm, LLC		11,395		—		11,395
Acquisition of CredentialMyDoc		—		4,657		4,657
Balance at December 31, 2019	$	27,776	$	74,420	$	102,196

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2018	$	16,381	$	69,763	$	86,144
Changes in carrying amount		—		—		—
Balance at December 31, 2018	$	16,381	$	69,763	$	86,144

Identifiable Intangible Assets

Identifiable intangible assets are comprised of the following (in thousands):

	As of December 31, 2019							As of December 31, 2018
	Gross Amount		Accumulated Amortization			Net		Gross Amount		Accumulated Amortization			Net
Customer related	$	82,314	$	(29,760	)	$	52,554	$	76,714	$	(23,245	)	$	53,469
Other		20,262		(12,735	)		7,527		15,572		(9,663	)		5,909
Total	$	102,576	$	(42,495	)	$	60,081	$	92,286	$	(32,908	)	$	59,378

Expected Annual Amortization Expense

The expected future annual amortization expense for the years ending December 31, is as follows (in thousands):

2020	$	9,683
2021		8,914
2022		7,835
2023		7,186
2024		5,679
Thereafter		20,784
Total	$	60,081

Business Combinations (Tables)

12 Months Ended

Dec. 31, 2019

Providigm, LLC [Member]

Summary of Purchase Price

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

Cash paid at closing (including the post-closing working capital adjustment)	$	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 fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Accounts and unbilled receivable, net	$	960
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,395
Intangible assets		5,950
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):

	Fair Value		Useful life
Customer relationships	$	3,500	12 years
Developed technology		2,200	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	5,950

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

Revenues, net		$	6,916
Operating loss		$	(491	)

Summary of Unaudited Pro Forma Financial Information

	For the twelve months ended
	2019		2018
Total revenues	$	254,437	$	243,992
Income from continuing operations	$	14,262	$	13,102
Net income	$	15,836	$	32,068
Net income per share - basic	$	0.49	$	0.99
Net income per share - diluted	$	0.49	$	0.99

CredentialMyDoc [Member]

Summary of Purchase Price

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

Cash paid at closing	$	7,920
Cash held in escrow		1,080
Total consideration paid	$	9,000

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	$	216
Prepaid and other current assets		3
Operating lease right-of-use assets		30
Deferred tax assets		71
Goodwill		4,657
Intangible assets		4,340
Accounts payable and accrued liabilities		(7	)
Deferred revenue		(280	)
Operating lease liabilities		(30	)
Net assets acquired	$	9,000

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	$	2,100	9 years
Developed technology		2,100	4 years
Non-compete		110	5 years
Trade name		30	3 years
Total intangible assets subject to amortization	$	4,340

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

Total revenues		$	34
Operating loss		$	(49	)

Summary of Unaudited Pro Forma Financial Information

	Year Ended December 31,
	2019		2018
Total revenues	$	256,053	$	236,445
Income from continuing operations	$	13,936	$	12,687
Net income	$	15,510	$	31,652
Net income per share - basic	$	0.48	$	0.98
Net income per share - diluted	$	0.48	$	0.98

Business Segments (Tables)

12 Months Ended

Dec. 31, 2019

Segment Reporting [Abstract]

Business Segment Information Based on Net Revenues and Operating Income

The following is the Company’s business segment information as of and for the years ended December 31, 2019, 2018, and 2017 (in thousands).

Revenues, net:	2019			2018			2017
Workforce Solutions	$	208,599		$	190,139		$	178,061
Provider Solutions		45,513			41,477			36,838
Total revenues, net	$	254,112		$	231,616		$	214,899

Operating income:	2019			2018			2017
Workforce Solutions	$	40,296		$	38,834		$	33,579
Provider Solutions		5,384			3,474			879
Unallocated		(30,960	)		(26,817	)		(25,051	)
Total operating income	$	14,720		$	15,491		$	9,407

Business Segment Information Based on Assets

	Assets*				Purchases of long-lived assets						Depreciation and amortization
	2019		2018		2019		2018		2017		2019		2018		2017
Workforce Solutions	$	118,382	$	104,668	$	14,972	$	12,820	$	9,888	$	10,813	$	9,780	$	9,982
Provider Solutions		148,398		145,637		2,959		5,240		3,619		9,757		8,895		8,147
Discontinued operations		—		—		—		180		2,764		—		181		2,235
Unallocated		222,764		191,643		13,602		7,191		1,762		7,299		5,375		5,919
Total	$	489,544	$	441,948	$	31,533	$	25,431	$	18,033	$	27,869	$	24,231	$	26,283

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Summary of Provision (Benefit) for Income Taxes

The provision (benefit) for income taxes is comprised of the following (in thousands):

	Year Ended December 31,
	2019		2018			2017
Current federal	$	233	$	(79	)	$	1,819
Current state		634		386			923
Deferred federal		2,717		2,661			(1,464	)
Deferred state		149		356			24
Provision for income taxes	$	3,733	$	3,324		$	1,302

Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes

	Year Ended December 31,
	2019			2018			2017
Federal tax provision at the statutory rate	$	3,765		$	3,482		$	3,549
State income tax provision, net of federal benefit		895			658			491
Tax credits		(614	)		(509	)		(583	)
Change in state valuation allowance		(247	)		2			151
Tax Act revaluation of deferred tax balances		—			—			(1,680	)
Stock compensation		(117	)		(560	)		(626	)
Other		51			251			—
Provision for income taxes	$	3,733		$	3,324		$	1,302

Reconciliation of the Beginning and Ending liability for Gross Unrecognized Tax Benefits

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits are as follows (in thousands):

	December 31,
	2019		2018
Balance at beginning of year	$	317	$	340
Additions for tax positions in the current year		—		—
Reductions for tax positions of prior years		—		(23	)
Balance at end of year	$	317	$	317

Significant Components of Deferred Tax Assets and Deferred Tax Liabilities

Significant components of deferred tax assets and deferred tax liabilities are as follows (in thousands):

	December 31,
	2019			2018
Deferred tax assets:
Allowance for doubtful accounts	$	215		$	297
Accrued liabilities		1,775			1,887
Lease liability		8,778			389
Stock based compensation		683			623
Deferred revenue		198			135
Basis difference on investments		381			396
Net operating loss carryforwards		263			291
Total deferred tax assets		12,293			4,018
Less: Valuation allowance		(64	)		(311	)
Deferred tax assets, net of valuation allowance		12,229			3,707
Deferred tax liabilities:
Deductible goodwill		2,236			1,760
Nondeductible intangible assets		801			1,049
Right of use assets		7,773			—
Prepaid assets		6,275			5,698
Capitalized software development		5,580			4,746
Depreciation		2,478			659
PX sale deferral		—			718
Total deferred tax liabilities		25,143			14,630

Net deferred tax liabilities	$	12,914		$	10,923

Stock Based Compensation (Tables)

12 Months Ended

Dec. 31, 2019

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Summary of Activity and Various Other Information Relative to Stock Options

A summary of activity and various other information relative to stock options for the year ended December 31, 2019 is presented in the tables below (in thousands, except exercise price).

				Weighted-
	Common			Average		Aggregate
	Shares			Exercise Price		Intrinsic Value
Outstanding at beginning of period		19		$	11.27
Granted		—			—
Exercised		(19	)		11.27
Expired		—			—
Forfeited		—			—
Outstanding at end of period		—		$	—	$	—
Exercisable at end of period		—		$	—	$	—

Other Information Relative to Option Activity

Other information relative to option activity during the three years ended December 31, 2019 is as follows (in thousands):

	2019		2018		2017
Total intrinsic value of stock options exercised	$	277	$	6,130	$	1,973
Cash proceeds from exercise of stock options	$	214	$	2,582	$	413

Summary of Activity Relative to RSU's

A summary of activity relative to RSUs for the year ended December 31, 2019 is as follows (in thousands, except weighted average grant date fair value):

				Weighted-
	Number of			Average Grant Date		Aggregate
	RSU’s			Fair Value		Intrinsic Value
Outstanding at beginning of period		289		$	24.31
Granted		100			27.24
Vested		(82	)		23.29
Forfeited		(19	)		24.38
Outstanding at end of period		288		$	25.61	$	7,847

Stock Based Compensation Expense Recorded in Consolidated Statements of Income

Total stock based compensation expense, which is recorded in our Consolidated Statements of Income, recorded for the years ended December 31, is as follows (in thousands):

	Years Ended December 31,
	2019		2018		2017
Cost of revenues (excluding depreciation and amortization)	$	699	$	37	$	29
Product development		956		296		228
Sales and marketing		614		183		244
Other general and administrative		1,975		1,261		1,235
Total stock based compensation expense	$	4,244	$	1,777	$	1,736

Discontinued Operations (Tables)

12 Months Ended

Dec. 31, 2019

Discontinued Operations And Disposal Groups [Abstract]

Schedule of Discontinued Operations, Income Statement

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

	Year Ended December 31,
	2018			2017
Revenues, net	$	3,342		$	32,763
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		1,982			18,792
Product development		554			3,751
Sales and marketing		460			4,310
Other general and administrative expenses		229			3,282
Depreciation and amortization		181			2,235
Total operating costs and expenses		3,406			32,370

Operating (loss) income		(64	)		393

Other income		—			—

(Loss) income from discontinued operations before income tax provision		(64	)		393
Income tax benefit		—			(773	)
(Loss) income from discontinued operations, net of income taxes	$	(64	)	$	1,166

- 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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+ Details

Leases (Tables)

12 Months Ended

Dec. 31, 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 Consolidated Balance Sheet as of December 31, 2019 (in thousands).

Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	29,615
Total leased assets		$	29,615
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,797
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		30,733
Total operating lease liabilities		$	33,530

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 December 31, 2019 (in thousands).

2020	$	4,749
2021		4,591
2022		4,124
2023		3,979
Thereafter		28,655
Total undiscounted lease payments	$	46,098
Less imputed interest		12,568
Total lease liabilities	$	33,530

Summary of Significant Accounting Policies - Additional Information (Detail)		12 Months Ended
	Feb. 12, 2018 USD ($)	Dec. 31, 2019 USD ($) Segment SourcesofTaxableIncome Plan	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)
Business And Basis Of Presentation [Line Items]
Number of operating segments \| Segment		2
Maturity of unrestricted cash equivalent		less than three months
Deferred commissions, amortization period		3 years
Assets amortized cost		3 years
Capitalized software development amount		$ 14,100,000	$ 11,900,000
Amortization of capitalized software development from continuing operations		11,000,000.0	9,600,000	$ 8,900,000
Capitalized software development costs for external computer software developed for resale		0	0
Goodwill impairments identified or recorded		0	0	0
Impairments identified or recorded		0	0	0
Impairments identified or recorded for long-lived assets		$ 0	0	0
Number of sources of taxable income \| SourcesofTaxableIncome		4
Valuation allowance		$ 64,000	311,000
Concentration risk, customer		The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2019, 2018, or 2017
Number of stock based compensation plans \| Plan		2
Sales and Marketing Expense [Member]
Business And Basis Of Presentation [Line Items]
Advertising expense		$ 765,000	$ 721,000	$ 868,000
Minimum [Member]
Business And Basis Of Presentation [Line Items]
Royalty payments amortization period		1 year
Finite lived intangible assets amortization period		3 years
Maximum [Member]
Business And Basis Of Presentation [Line Items]
Royalty payments amortization period		5 years
Finite lived intangible assets amortization period		13 years
Weighted Average [Member]
Business And Basis Of Presentation [Line Items]
Finite lived intangible assets amortization period		11 years
Patient Experience Solutions [Member]
Business And Basis Of Presentation [Line Items]
Consideration received	$ 65,200,000

Summary of Significant Accounting Policies - Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Allowance Balance at Beginning of Period	$ 1,161	$ 1,979	$ 839
Charged to Costs and Expenses	211	1,033	1,568
Write-offs	(529)	(1,851)	(428)
Allowance Balance at End of Period	$ 843	$ 1,161	$ 1,979

Summary of Significant Accounting Policies - Estimated Useful Lives of Property and Equipment (Detail)	12 Months Ended
	Dec. 31, 2019
Furniture and Fixtures [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	5 years
Furniture and Fixtures [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	7 years
Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	3 years

Shareholders' Equity - Additional Information (Detail) - shares	Dec. 31, 2019	Dec. 31, 2018
Equity [Abstract]
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	32,379,000	32,325,000
Common stock, shares outstanding	32,379,000	32,325,000
Preferred stock, shares authorized	10,000,000

Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Numerator:
Income from continuing operations	$ 14,196	$ 13,251	$ 8,838
Income from discontinued operations	1,574	18,966	1,166
Net income	$ 15,770	$ 32,217	$ 10,004
Denominator:
Weighted-average shares outstanding	32,372	32,264	31,861
Effect of dilutive shares	56	71	335
Weighted-average diluted shares	32,428	32,335	32,196
Earnings per share – basic:
Continuing operations	$ 0.44	$ 0.41	$ 0.27
Discontinued operations	0.05	0.59	0.04
Net income per share - basic	0.49	1.00	0.31
Earnings per share – diluted:
Continuing operations	0.44	0.41	0.27
Discontinued operations	0.05	0.59	0.04
Net income per share - diluted	$ 0.49	$ 1.00	$ 0.31

Earnings Per Share - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Total number of common equivalent shares excluded from the calculations of diluted earnings per share	93,000	91,000	58,000

Marketable Securities - Fair Value of Available for Sale Marketable Securities (Detail) - Level 2 [Member] - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	$ 41,326	$ 34,520
Available for sale securities, Unrealized Gains	7
Available for sale securities, Unrealized Losses	(5)	(23)
Available for sale securities, Fair Value	41,328	34,497
Corporate Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	37,325	31,521
Available for sale securities, Unrealized Gains	7
Available for sale securities, Unrealized Losses	(5)	(23)
Available for sale securities, Fair Value	37,327	31,498
Government-Sponsored Enterprises Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	4,001	2,999
Available for sale securities, Fair Value	$ 4,001	$ 2,999

Revenue Recognition and Sales Commissions - Schedule of Revenues Included in Continuing Operations Disaggregated by Revenue Source (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 254,112	$ 231,616	$ 214,899
Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	208,599	190,139
Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	45,513	41,477
Subscription Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	240,501	220,468
Subscription Services [Member] \| Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	202,479	184,926
Subscription Services [Member] \| Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	38,022	35,542
Professional Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	13,611	11,148
Professional Services [Member] \| Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	6,120	5,213
Professional Services [Member] \| Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 7,491	$ 5,935

Revenue Recognition and Sales Commissions - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Revenue Recognition and Sales Commissions [Line Items]
Revenues recognized in period, included in deferred revenue at beginning of the period	$ 64,700	$ 63,700
Estimated revenue expected to be recognized in future under contract with customers	$ 433,000
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 included multiple payments, including an initial payment in the period a customer contract is obtained and subsequent payments either 15 or 27 months after the initial payment.
Amortization of deferred commissions	$ 8,305	7,659
Customer Contracts [Member]
Revenue Recognition and Sales Commissions [Line Items]
Impairment losses on receivables and contract asset	$ 200	$ 1,000

Revenue Recognition and Sales Commissions - Additional Information (Detail 1) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date: 2020-01-01	Dec. 31, 2019
Revenue Recognition and Sales Commissions [Line Items]
Estimated revenue, expected recognition period	12 months
Percentage of remaining performance obligations expects revenue	47.00%

Property and Equipment - Summary of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 45,356	$ 36,693
Accumulated depreciation and amortization	(19,291)	(20,827)
Property and equipment, net	26,065	15,866
Equipment [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	25,199	21,129
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	14,909	11,572
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 5,248	$ 3,992

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Property Plant And Equipment [Abstract]
Depreciation of property and equipment	$ 7.3	$ 5.5	$ 5.9

Goodwill and Intangible Assets - Changes in Carrying Amount of Goodwill (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Line Items]
Goodwill, beginning balance	$ 86,144	$ 86,144
Changes in carrying amount		0
Goodwill, ending balance	102,196	86,144
Providigm, LLC [Member]
Goodwill [Line Items]
Goodwill acquired	11,395
CredentialMyDoc [Member]
Goodwill [Line Items]
Goodwill acquired	4,657
Workforce Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	16,381	16,381
Changes in carrying amount		0
Goodwill, ending balance	27,776	16,381
Workforce Solutions [Member] \| Providigm, LLC [Member]
Goodwill [Line Items]
Goodwill acquired	11,395
Provider Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	69,763	69,763
Changes in carrying amount		0
Goodwill, ending balance	74,420	$ 69,763
Provider Solutions [Member] \| CredentialMyDoc [Member]
Goodwill [Line Items]
Goodwill acquired	$ 4,657

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill [Line Items]
Amortization of intangible assets	$ 9,600	$ 9,100	$ 9,200
Minimum [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	3 years
Minimum [Member] \| Customer Relationships [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	5 years
Minimum [Member] \| Other Intangible Assets [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	3 years
Maximum [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	13 years
Maximum [Member] \| Customer Relationships [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	13 years
Maximum [Member] \| Other Intangible Assets [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	9 years
Providigm, LLC [Member]
Goodwill [Line Items]
Goodwill acquired	$ 11,395
CredentialMyDoc [Member]
Goodwill [Line Items]
Goodwill acquired	$ 4,657

Goodwill and Intangible Assets - Identifiable Intangible Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finite Lived Intangible Assets [Line Items]
Gross Amount	$ 102,576	$ 92,286
Accumulated Amortization	(42,495)	(32,908)
Net	60,081	59,378
Customer Relationships [Member]
Finite Lived Intangible Assets [Line Items]
Gross Amount	82,314	76,714
Accumulated Amortization	(29,760)	(23,245)
Net	52,554	53,469
Other Intangible Assets [Member]
Finite Lived Intangible Assets [Line Items]
Gross Amount	20,262	15,572
Accumulated Amortization	(12,735)	(9,663)
Net	$ 7,527	$ 5,909

Goodwill and Intangible Assets - Expected Annual Amortization Expense (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Goodwill And Intangible Assets Disclosure [Abstract]
2020	$ 9,683
2021	8,914
2022	7,835
2023	7,186
2024	5,679
Thereafter	20,784
Net	$ 60,081	$ 59,378

Business Combinations - Additional Information (Detail) - USD ($)			12 Months Ended		24 Months Ended
	Dec. 16, 2019	Jan. 10, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2019
Providigm, LLC [Member]
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
Providigm, LLC [Member] \| Recovery of Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow		$ 3,650,000
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash	$ 9,000,000
Net tangible assets include deferred revenue book value at acquisition date	595,000
Net tangible assets include deferred revenue fair value at acquisition date	280,000
Write-down of deferred revenue	$ 315,000
Preliminary purchase price allocation measurement period from acquisition date	1 year
CredentialMyDoc [Member] \| Recovery of Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow	$ 1,100,000

Business Combinations - Summary of Purchase Price (Detail) - USD ($) $ in Thousands	Dec. 16, 2019	Jan. 10, 2019
Providigm, LLC [Member]
Business Acquisition [Line Items]
Total consideration paid		$ 18,018
Providigm, LLC [Member] \| Cash Paid at Closing (Including the Post-Closing Working Capital Adjustment) [Member]
Business Acquisition [Line Items]
Total consideration paid		14,368
Providigm, LLC [Member] \| Cash Held in Escrow [Member]
Business Acquisition [Line Items]
Total consideration paid		$ 3,650
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 9,000
CredentialMyDoc [Member] \| Cash Held in Escrow [Member]
Business Acquisition [Line Items]
Total consideration paid	1,080
CredentialMyDoc [Member] \| Cash Paid at Closing [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 7,920

Business Combinations - Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed (Detail) - USD ($)	Dec. 31, 2019	Dec. 16, 2019	Jan. 10, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 102,196,000			$ 86,144,000	$ 86,144,000
Providigm, LLC [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net			$ 960,000
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			11,395,000
Intangible assets			5,950,000
Accounts payable and accrued liabilities			(1,196,000)
Deferred revenue			(141,000)
Operating lease liabilities			(1,233,000)
Net assets acquired			$ 18,018,000
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net		$ 216,000
Prepaid assets		3,000
Operating lease right-of-use assets		30,000
Deferred tax assets		71,000
Goodwill		4,657,000
Intangible assets		4,340,000
Accounts payable and accrued liabilities		(7,000)
Deferred revenue		(280,000)
Operating lease liabilities		(30,000)
Net assets acquired		$ 9,000,000

Business Combinations - Summary of Preliminary Components of Identifiable Intangible Assets and Estimated Useful Lives (Detail) - USD ($) $ in Thousands	Dec. 16, 2019	Jan. 10, 2019
Providigm, LLC [Member]
Business Acquisition [Line Items]
Preliminary Fair Value		$ 5,950
Providigm, LLC [Member] \| Customer Relationships [Member]
Business Acquisition [Line Items]
Preliminary Fair Value		$ 3,500
Useful life		12 years
Providigm, LLC [Member] \| Developed Technology [Member]
Business Acquisition [Line Items]
Preliminary Fair Value		$ 2,200
Useful life		5 years
Providigm, LLC [Member] \| Trade Name [Member]
Business Acquisition [Line Items]
Preliminary Fair Value		$ 250
Useful life		7 years
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 4,340
CredentialMyDoc [Member] \| Customer Relationships [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 2,100
Useful life	9 years
CredentialMyDoc [Member] \| Developed Technology [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 2,100
Useful life	4 years
CredentialMyDoc [Member] \| Trade Name [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 30
Useful life	3 years
CredentialMyDoc [Member] \| Non-Compete [Member]
Business Acquisition [Line Items]
Preliminary Fair Value	$ 110
Useful life	5 years

Business Combinations - Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statement of Income since the Date of Acquisition (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Providigm, LLC [Member]
Business Acquisition [Line Items]
Revenues, net	$ 6,916
Operating loss	(491)
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Revenues, net	34
Operating loss	$ (49)

Business Combinations - Summary of Unaudited Pro Forma Financial Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Providigm, LLC [Member]
Business Acquisition [Line Items]
Total revenues	$ 254,437	$ 243,992
Income from continuing operations	14,262	13,102
Net income	$ 15,836	$ 32,068
Net income per share - basic	$ 0.49	$ 0.99
Net income per share - diluted	$ 0.49	$ 0.99
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Total revenues	$ 256,053	$ 236,445
Income from continuing operations	13,936	12,687
Net income	$ 15,510	$ 31,652
Net income per share - basic	$ 0.48	$ 0.98
Net income per share - diluted	$ 0.48	$ 0.98

Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Revenues, net:
Revenues, net	$ 254,112	$ 231,616	$ 214,899
Operating income:
Operating income	14,720	15,491	9,407
Workforce Solutions [Member]
Revenues, net:
Revenues, net	208,599	190,139
Provider Solutions [Member]
Revenues, net:
Revenues, net	45,513	41,477
Operating Segments [Member] \| Workforce Solutions [Member]
Revenues, net:
Revenues, net	208,599	190,139	178,061
Operating income:
Operating income	40,296	38,834	33,579
Operating Segments [Member] \| Provider Solutions [Member]
Revenues, net:
Revenues, net	45,513	41,477	36,838
Operating income:
Operating income	5,384	3,474	879
Unallocated [Member]
Operating income:
Operating income	$ (30,960)	$ (26,817)	$ (25,051)

Business Segments - Business Segment Information Based on Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Total assets	$ 489,544	$ 441,948
Total purchases of long-lived assets	31,533	25,431	$ 18,033
Total depreciation and amortization	27,869	24,231	26,283
Operating Segments [Member] \| Workforce Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	118,382	104,668
Total purchases of long-lived assets	14,972	12,820	9,888
Total depreciation and amortization	10,813	9,780	9,982
Operating Segments [Member] \| Provider Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	148,398	145,637
Total purchases of long-lived assets	2,959	5,240	3,619
Total depreciation and amortization	9,757	8,895	8,147
Unallocated [Member]
Segment Reporting Information [Line Items]
Total assets	222,764	191,643
Total purchases of long-lived assets	13,602	7,191	1,762
Total depreciation and amortization	$ 7,299	5,375	5,919
Discontinued Operations [Member]
Segment Reporting Information [Line Items]
Total purchases of long-lived assets		180	2,764
Total depreciation and amortization		$ 181	$ 2,235

Income Taxes - Summary of Provision (Benefit) for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Current federal	$ 233	$ (79)	$ 1,819
Current state	634	386	923
Deferred federal	2,717	2,661	(1,464)
Deferred state	149	356	24
Provision for income taxes	$ 3,733	$ 3,324	$ 1,302

Income Taxes - Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal tax provision at the statutory rate	$ 3,765	$ 3,482	$ 3,549
State income tax provision, net of federal benefit	895	658	491
Tax credits	(614)	(509)	(583)
Change in state valuation allowance	(247)	2	151
Tax Act revaluation of deferred tax balances			(1,680)
Stock compensation	(117)	(560)	(626)
Other	51	251
Provision for income taxes	$ 3,733	$ 3,324	$ 1,302

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Taxes Disclosure [Line Items]
Valuation allowance	$ 64,000	$ 311,000
U.S. federal corporate income tax rate	21.00%
Unrecognized tax benefits	$ 317,000	317,000
Interest and penalties related to unrecognized tax benefits	14,000	$ 2,000
Excess tax benefits related to stock based awards	117,000
State [Member]
Income Taxes Disclosure [Line Items]
Net operating loss carryforwards	$ 5,000,000.0
Earliest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years	Dec. 31, 2031
Latest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years	Dec. 31, 2040

Income Taxes - Reconciliation of the Beginning and Ending Liability for Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 317	$ 340
Additions for tax positions in the current year	0	0
Reductions for tax positions of prior years		(23)
Balance at end of year	$ 317	$ 317

Income Taxes - Significant Components of Deferred Tax Assets and Deferred Tax Liabilities (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Deferred tax assets:
Allowance for doubtful accounts	$ 215,000	$ 297,000
Accrued liabilities	1,775,000	1,887,000
Lease liability	8,778,000	389,000
Stock based compensation	683,000	623,000
Deferred revenue	198,000	135,000
Basis difference on investments	381,000	396,000
Net operating loss carryforwards	263,000	291,000
Total deferred tax assets	12,293,000	4,018,000
Less: Valuation allowance	(64,000)	(311,000)
Deferred tax assets, net of valuation allowance	12,229,000	3,707,000
Deferred tax liabilities:
Deductible goodwill	2,236,000	1,760,000
Nondeductible intangible assets	801,000	1,049,000
Right of use assets	7,773,000
Prepaid assets	6,275,000	5,698,000
Capitalized software development	5,580,000	4,746,000
Depreciation	2,478,000	659,000
PX sale deferral		718,000
Total deferred tax liabilities	25,143,000	14,630,000
Net deferred tax liabilities	$ 12,914,000	$ 10,923,000

Stock Based Compensation - Additional Information (Detail)			1 Months Ended	3 Months Ended	12 Months Ended
	Jun. 30, 2019 shares	Jun. 26, 2019 USD ($) Employee shares	Jun. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Dec. 31, 2019 USD ($) shares	Dec. 31, 2018 USD ($) shares	Dec. 31, 2017 USD ($) shares	Dec. 30, 2019 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unissued common stock reserved for future stock option grants \| shares					867,000
Closing stock price \| $ / shares								$ 27.22
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities					$ 1,034,000	$ 338,000	$ 412,000
Excess tax benefits related to stock based awards					$ 117,000
Stock options granted \| shares					0
Stock based compensation expense					$ 4,244,000	1,777,000	1,736,000
Payments related to employees' tax obligations to taxing authorities for stock awards					600,000
Employer tax and expenses for stock awards			$ 200,000
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		$ 2,000,000.0
Number of additional shares contributed to the company \| shares	7,852
Stock Options and RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation expense related to non-vested stock options and RSUs					$ 3,500,000
Weighted average expense recognition period					2 years 4 months 24 days
RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate fair value of RSU awards that vested					$ 1,900,000	$ 1,800,000
Shares withheld for RSUs \| shares					15,000	13,000
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities					$ 400,000	$ 300,000	$ 400,000
Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options granted \| shares					0	0	0
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				$ 2,000,000.0
Maximum [Member] \| Stock Options and RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of the options and RSU's granted					4 years

Stock Based Compensation - Summary of Activity and Various Other Information Relative to Stock Options (Detail) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	19
Granted, Common Shares \| shares	0
Exercised, Common Shares \| shares	(19)
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	0
Exercisable at end of period, Common Shares \| shares	0
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 11.27
Granted, Weighted-Average Exercise Price \| $ / shares	0
Exercised, Weighted-Average Exercise Price \| $ / shares	11.27
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	0
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 0
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 0

Stock Based Compensation - Other Information Relative to Option Activity (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Total intrinsic value of stock options exercised	$ 277	$ 6,130	$ 1,973
Cash proceeds from exercise of stock options	$ 214	$ 2,582	$ 413

Stock Based Compensation - Summary of Activity Relative to RSU's (Detail) - RSUs [Member] $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding at beginning of period, shares \| shares	289
Granted \| shares	100
Vested \| shares	(82)
Forfeited \| shares	(19)
Outstanding at end of period, shares \| shares	288
Outstanding at beginning of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 24.31
Granted, Weighted-Average Grant Date Fair Value \| $ / shares	27.24
Vested, Weighted-Average Grant Date Fair Value \| $ / shares	23.29
Forfeited, Weighted-Average Grant Date Fair Value \| $ / shares	24.38
Outstanding at end of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 25.61
Aggregate intrinsic Value \| $	$ 7,847

Stock Based Compensation - Stock Based Compensation Expense Recorded in Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 4,244	$ 1,777	$ 1,736
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	699	37	29
Product Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	956	296	228
Sales and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	614	183	244
Other General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 1,975	$ 1,261	$ 1,235

Employee Benefit Plan - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Schedule Of Sale Of Subsidiary [Abstract]
Employees minimum age eligibility to participate in plan	21 years
Minimum number of days required to be eligible for participation in plan	30 days
Defined contribution plan, employer matching contribution amount	$ 1.4	$ 1.3	$ 0.7

Discontinued Operations - Additional Information (Detail) - Patient Experience Solutions [Member] - USD ($) $ in Millions		12 Months Ended
	Feb. 12, 2018	Dec. 31, 2019	Dec. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration received	$ 65.2
Gain on sale of business, net of tax	$ 20.5	$ 1.5	$ 19.0

Discontinued Operations - Schedule of Discontinued Operations Income Statement (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Operating costs and expenses:
(Loss) income from discontinued operations before income tax provision		$ (64)	$ 393
Income tax benefit	$ 479	10,459	(773)
Income from discontinued operations	$ 1,574	18,966	1,166
Patient Experience Solutions [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenues, net		3,342	32,763
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		1,982	18,792
Product development		554	3,751
Sales and marketing		460	4,310
Other general and administrative expenses		229	3,282
Depreciation and amortization		181	2,235
Total operating costs and expenses		3,406	32,370
Operating (loss) income		(64)	393
(Loss) income from discontinued operations before income tax provision		(64)	393
Income tax benefit			(773)
Income from discontinued operations		$ (64)	$ 1,166

Debt - Additional Information (Detail) - USD ($)	12 Months Ended
Debt - Additional Information (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Debt outstanding	$ 0	$ 0
SunTrust Bank [Member]
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.
SunTrust Bank [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.20%
SunTrust Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.30%
Revolving Credit Facility [Member] \| SunTrust Bank [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 borrowings	0
Revolving Credit Facility [Member] \| SunTrust Bank [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] \| SunTrust Bank [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] \| SunTrust Bank [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] \| SunTrust Bank [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	1.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Interest coverage ratio	300.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Minimum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	0.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Minimum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Debt leverage ratio	300.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	2.00%

Leases - Additional Information (Detail)	12 Months Ended
Leases - Additional Information (Detail)	Dec. 31, 2019 USD ($) Lease	Jan. 01, 2020 USD ($)	Jan. 01, 2019 USD ($)	Dec. 31, 2018 USD ($)
Operating Leases Disclosure [Line Items]
Right-of-use assets	$ 29,615,000		$ 4,800,000
Operating lease, liability	$ 33,530,000		$ 6,400,000
Deferred rent liabilities				$ 1,600,000
Operating leases that have not yet commenced \| Lease	1
Operating lease cost	$ 4,900,000
Cash paid for amounts included in the measurement of operating lease liabilities	$ 2,500,000
Operating lease, weighted-average remaining lease term	10 years 7 months 6 days
Operating lease, weighted-average incremental borrowing rate	6.00%
Subsequent Event [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets		$ 85,000
Operating lease, liability		$ 85,000
Nashville, TN [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	$ 26,500,000
Operating lease, liability	26,500,000
Providigm, LLC [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	1,200,000
Operating lease, liability	1,200,000
CredentialMyDoc [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	30,000
Operating lease, liability	$ 30,000

Leases - Schedule of Lease-Related Assets and Liabilities Recorded on Condensed Consolidated Balance Sheet (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Leases [Abstract]
Operating lease right of use assets, net	$ 29,615	$ 4,800
Operating lease liabilities, current	$ 2,797
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent
Operating lease liability, non-current	$ 30,733
Total operating lease liabilities	$ 33,530	$ 6,400

Leases - Schedule of Maturities of Lease Liabilities Under Non-Cancellable Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Leases [Abstract]
2020	$ 4,749
2021	4,591
2022	4,124
2023	3,979
Thereafter	28,655
Total undiscounted lease payments	46,098
Less imputed interest	12,568
Total lease liabilities	$ 33,530	$ 6,400

Collaborative Arrangement - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Feb. 28, 2018
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Collaborative arrangement profit/loss sharing percentage			50.00%
Expenses related to collaborative arrangement	$ 187,000	$ 1,200,000
Collaborative Arrangement, Product [Member]
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Collaborative arrangement revenues	$ 391,000	$ 2,200,000

Non-Marketable Equity Investments - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2019
Investments Debt And Equity Securities [Abstract]
Reduction to carrying value of non-marketable equity investment due to downward change in fair value	$ 1,271
Aggregate carrying amount of non-marketable equity investments	$ 2,100	$ 5,400

Subsequent Event - Additional Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2020 USD ($)
Scenario, Forecast [Member]
Subsequent Event [Line Items]
Cost of goods and services sold, derecognized	$ 3.4

Stock Based Compensation - Summary of Activity and Various Other Information Relative to Stock Options (Detail) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	19
Granted, Common Shares \| shares	0
Exercised, Common Shares \| shares	(19)
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	0
Exercisable at end of period, Common Shares \| shares	0
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 11.27
Granted, Weighted-Average Exercise Price \| $ / shares	0
Exercised, Weighted-Average Exercise Price \| $ / shares	11.27
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	0
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 0
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 0