For physicians in primary care, the workday rarely ends at the exam room door. Patient messages, test results, referral requests and prescription renewals accumulate in the electronic in-basket hours after the last appointment.
“In basket management is a killer for so many people,” said Leanne Yanni, MD, president and CEO of the Illinois Physician Enterprise for Hospital Sisters Health System in Springfield, Ill., during an episode of the “Becker’s Healthcare Podcast.”
Dr. Yanni oversees about 320 physicians and advanced practice providers across 60 core and 60 outreach locations in Central and Southern Illinois, an enterprise that still runs largely on a one-to-one care model in which individual physicians carry the weight of both clinical and administrative responsibilities. That is the structure she is working to redesign.
Her strategy centers on team-based care, a model in which every member of the clinical team practices at the top of their license and administrative tasks are distributed rather than concentrated on the physician. The goal is as much about retention as efficiency. In primary care especially, in-basket work that follows physicians home has driven burnout and attrition, and Dr. Yanni sees it as one of the clearest targets for operational change.
Artificial intelligence is part of the plan for high-volume, repetitive work. The in-basket, however, is where clinical judgment lives.
“I know there’s hope that AI will help manage it,” she said. “It still is so nuanced that you need humans in the in-basket to manage these messages.”
The leadership infrastructure for team-based care is already being assembled. Dr. Yanni’s first year included establishing a formal advanced practice provider council and creating dedicated APP leadership positions. About half of the enterprise’s 320 clinicians are advanced practice providers — a fact that had not previously been reflected at the governance level.
“We now have three excellent APP leads in those roles, working alongside in a triad model with our executive medical directors as well as our operational directors,” she said.
That triad — executive medical director, APP lead and operational director working together — is designed to bring advanced practice providers’ perspectives into practice-level decisions and to carry team-based care workflows into the sites where in-basket and administrative burden are most acute.
Where technology has already proven its value is in ambient AI, which the enterprise has deployed to every physician and APP across its ambulatory group and hospital sites. Dr. Yanni obtained her Illinois medical license after joining the system and began seeing patients herself to experience the technology firsthand.
“I cannot believe the difference. And I actually think back to my many years of practice, when my kids were little, and the hours I spent on my notes. The late nights I would get home, seven, eight, nine o’clock was not uncommon,” she said. “It makes me a little sad that I didn’t have this ambient AI technology that could have done so much work for me and helped me balance having a career with having kids at home.”
The in-basket problem is more dependent on clinical judgment and therefore not a place where technology can simply absorb all the work. Dr. Yanni is studying organizations that have moved furthest toward integrated team-based primary care models and plans to send leaders to learn from them directly.
“We really want to help do a lot more team based modeling as to how do we manage the administrative task and the clinical task more as a team, again, practicing top of license and freeing people up to really be face to face with patients as much as possible,” she said.
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