# Grounded by Experience: Generative Healthcare Prediction Augmented with Hierarchical Agentic Retrieval

arXiv: https://arxiv.org/abs/2511.13293 · HTML: https://mlsanity.com/paper/2511.13293/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 40 of its 64 references that are in the map.
- First posted on arXiv 17 Nov 2025.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 30 of 40)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Dense Passage Retrieval for Open-Domain Question Answering](https://mlsanity.com/paper/2004.04906/) (2020)
- [Billion-scale similarity search with GPUs](https://mlsanity.com/paper/1702.08734/) (2017)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [Search-R1: Training LLMs to Reason and Leverage Search Engines with Reinforcement Learning](https://mlsanity.com/paper/2503.09516/) (2025)
- [Rethinking the Role of Demonstrations: What Makes In-Context Learning Work?](https://mlsanity.com/paper/2202.12837/) (2022)
- [M3-Embedding: Multi-Linguality, Multi-Functionality, Multi-Granularity Text Embeddings Through Self-Knowledge Distillation](https://mlsanity.com/paper/2402.03216/) (2024)
- [The Surprising Effectiveness of PPO in Cooperative, Multi-Agent Games](https://mlsanity.com/paper/2103.01955/) (2021)
- [A Survey on RAG Meeting LLMs: Towards Retrieval-Augmented Large Language Models](https://mlsanity.com/paper/2405.06211/) (2024)
- [Multilingual E5 Text Embeddings: A Technical Report](https://mlsanity.com/paper/2402.05672/) (2024)
- [LightRAG: Simple and Fast Retrieval-Augmented Generation](https://mlsanity.com/paper/2410.05779/) (2024)
- [BioMistral: A Collection of Open-Source Pretrained Large Language Models for Medical Domains](https://mlsanity.com/paper/2402.10373/) (2024)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Agentic Retrieval-Augmented Generation: A Survey on Agentic RAG](https://mlsanity.com/paper/2501.09136/) (2025)
- [A Survey on Heterogeneous Graph Embedding: Methods, Techniques, Applications and Sources](https://mlsanity.com/paper/2011.14867/) (2020)
- [When MOE Meets LLMs: Parameter Efficient Fine-tuning for Multi-task Medical Applications](https://mlsanity.com/paper/2310.18339/) (2023)
- [Deep Reinforcement Learning for Page-wise Recommendations](https://mlsanity.com/paper/1805.02343/) (2018)
- [MedRAG: Enhancing Retrieval-augmented Generation with Knowledge Graph-Elicited Reasoning for Healthcare Copilot](https://mlsanity.com/paper/2502.04413/) (2025)
- [GraphCare: Enhancing Healthcare Predictions with Personalized Knowledge Graphs](https://mlsanity.com/paper/2305.12788/) (2023)
- [StageNet: Stage-Aware Neural Networks for Health Risk Prediction](https://mlsanity.com/paper/2001.10054/) (2020)
- [Reasoning-Enhanced Healthcare Predictions with Knowledge Graph Community Retrieval](https://mlsanity.com/paper/2410.04585/) (2024)
- [Modular RAG: Transforming RAG Systems into LEGO-like Reconfigurable Frameworks](https://mlsanity.com/paper/2407.21059/) (2024)
- [Improving Retrieval-Augmented Generation through Multi-Agent Reinforcement Learning](https://mlsanity.com/paper/2501.15228/) (2025)
- [M-RAG: Reinforcing Large Language Model Performance through Retrieval-Augmented Generation with Multiple Partitions](https://mlsanity.com/paper/2405.16420/) (2024)
- [GLBench: A Comprehensive Benchmark for Graph with Large Language Models](https://mlsanity.com/paper/2407.07457/) (2024)
- [ClinicalBench: Can LLMs Beat Traditional ML Models in Clinical Prediction?](https://mlsanity.com/paper/2411.06469/) (2024)
- [MedAgentBoard: Benchmarking Multi-Agent Collaboration with Conventional Methods for Diverse Medical Tasks](https://mlsanity.com/paper/2505.12371/) (2025)
- [G-Refer: Graph Retrieval-Augmented Large Language Model for Explainable Recommendation](https://mlsanity.com/paper/2502.12586/) (2025)
- [Pessimism in the Face of Confounders: Provably Efficient Offline Reinforcement Learning in Partially Observable Markov Decision Processes](https://mlsanity.com/paper/2205.13589/) (2022)

## Built on by (most cited first, 1 of 1)

- [Fusion and Alignment Enhancement with Large Language Models for Tail-item Sequential Recommendation](https://mlsanity.com/paper/2604.03688/) (2026)

## Abstract (arXiv)

Accurate healthcare prediction is critical for improving patient outcomes and reducing operational costs. Bolstered by growing reasoning capabilities, large language models (LLMs) offer a promising path to enhance healthcare predictions by drawing on their rich parametric knowledge. However, LLMs are prone to factual inaccuracies due to limitations in the reliability and coverage of their embedded knowledge. While retrieval-augmented generation (RAG) frameworks, such as GraphRAG and its variants, have been proposed to mitigate these issues by incorporating external knowledge, they face two key challenges in the healthcare scenario: (1) identifying the clinical necessity to activate the retrieval mechanism, and (2) achieving synergy between the retriever and the generator to craft contextually appropriate retrievals. To address these challenges, we propose GHAR, a underlinegenerative underlinehierarchical underlineagentic underlineRAG framework that simultaneously resolves when to retrieve and how to optimize the collaboration between submodules in healthcare. Specifically, for the first challenge, we design a dual-agent architecture comprising Agent-Top and Agent-Low. Agent-Top acts as the primary physician, iteratively deciding whether to rely on parametric knowledge or to initiate retrieval, while Agent-Low acts as the consulting service, summarising all task-relevant knowledge once retrieval was triggered. To tackle the second challenge, we innovatively unify the optimization of both agents within a formal Markov Decision Process, designing diverse rewards to align their shared goal of accurate prediction while preserving their distinct roles. Extensive experiments on three benchmark datasets across three popular tasks demonstrate our superiority over state-of-the-art baselines, highlighting the potential of hierarchical agentic RAG in advancing healthcare systems.