NetworkSim

Overview

NetworkSim provides healthcare network knowledge and synthetic entity generation for the HealthSim ecosystem. Unlike other products that generate transaction data (encounters, claims, prescriptions), NetworkSim focuses on the structural elements that support those transactions:

1. Reference Knowledge - Network types, plan structures, pharmacy benefits, PBM operations
2. Synthetic Generation - Providers, facilities, pharmacies, network configurations
3. Integration Patterns - Cross-product enhancement for realistic data

When to Use NetworkSim

Skill Categories

Reference Knowledge (reference/)

Educational content about healthcare networks, plan structures, and pharmacy benefits. Use these skills to understand concepts before generating synthetic data.

Synthetic Generation (synthetic/)

Generate realistic synthetic healthcare entities. Each skill produces canonical JSON that can be transformed to various output formats.

Patterns & Templates (patterns/)

Reusable configuration patterns for common network and benefit structures. Use these as starting points for customization.

Cross-Product Integration (integration/)

Enhance other HealthSim products with network context. These skills bridge NetworkSim entities into other product workflows.

Quick Start Examples

Example 1: Network Type Reference

User: What's the difference between an HMO and a PPO?

Claude: [Routes to reference/network-types.md]

HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) 
differ primarily in flexibility and cost:

| Aspect | HMO | PPO |
|--------|-----|-----|
| Network | Must use in-network providers | Can use any provider |
| Referrals | Required for specialists | Not required |
| PCP Required | Yes | No |
| Out-of-Network | Not covered (except emergency) | Covered at higher cost |
| Premiums | Lower | Higher |
| Cost Sharing | Lower | Higher |

HMOs work best for people who want lower costs and don't mind the gatekeeper model.
PPOs suit those who value flexibility and are willing to pay more for it.

Example 2: Generate a Provider

User: Generate a cardiologist in San Diego

Claude: [Routes to synthetic/synthetic-provider.md]

{
  "npi": "1234567890",
  "entity_type": "individual",
  "provider": {
    "last_name": "Martinez",
    "first_name": "Elena",
    "credential": "MD, FACC",
    "gender": "F"
  },
  "taxonomy": {
    "code": "207RC0000X",
    "classification": "Internal Medicine",
    "specialization": "Cardiovascular Disease",
    "display_name": "Cardiologist"
  },
  "practice_location": {
    "address_line_1": "4567 Cardiovascular Way",
    "address_line_2": "Suite 300",
    "city": "San Diego",
    "state": "CA",
    "zip": "92121",
    "county": "San Diego",
    "phone": "858-555-0142"
  },
  "hospital_affiliations": [
    {
      "name": "Scripps Memorial Hospital La Jolla",
      "ccn": "050678",
      "privileges": ["Admitting", "Surgical"]
    }
  ],
  "accepting_new_patients": true,
  "languages": ["English", "Spanish"]
}

Example 3: Cross-Product Integration

User: Generate a provider for this heart failure patient's cardiology referral

Claude: [Routes to integration/provider-for-encounter.md]

Based on the patient's heart failure diagnosis (I50.9) and location in Harris County, TX,
I'll generate an appropriate cardiologist:

{
  "npi": "1987654321",
  "entity_type": "individual",
  "provider": {
    "last_name": "Patel",
    "first_name": "Vikram",
    "credential": "MD, FACC, FHFSA",
    "gender": "M"
  },
  "taxonomy": {
    "code": "207RC0001X",
    "classification": "Internal Medicine",
    "specialization": "Advanced Heart Failure and Transplant Cardiology",
    "display_name": "Heart Failure Specialist"
  },
  "practice_location": {
    "city": "Houston",
    "state": "TX",
    "county_fips": "48201"
  },
  "integration_context": {
    "source_product": "patientsim",
    "matched_on": ["diagnosis_category", "geography"],
    "patient_diagnosis": "I50.9",
    "referral_reason": "Heart failure management"
  }
}

Related Products

NetworkSim integrates with all other HealthSim products:

Boundary Rules

Understanding what NetworkSim owns vs. what other products own:

NetworkSim Owns

• Network type knowledge and definitions
• Provider/facility/pharmacy entity generation
• Network configuration patterns
• Benefit design concepts (structure, not pricing)
• PBM operational concepts

Other Products Own

Collaboration Pattern

When generating data that spans boundaries:

1. NetworkSim generates the structural entity (provider, facility, pharmacy)
2. Other product consumes that entity in its workflow
3. Identity correlation maintained via NPI, CCN, NCPDP identifiers

Output Formats

NetworkSim entities can be output in multiple formats:

Documentation

• README - Product overview and quick start
• Developer Guide - Technical reference and workflows
• Prompt Guide - Example prompts by category

Version History

NetworkSim is part of the HealthSim ecosystem. For overall architecture, see the HealthSim Architecture Guide.