Population health accountability has been arriving gradually for years at health systems nationwide, through shared savings programs and value-based contracts that rewarded efficiency but kept most of the financial risk on Medicare’s side. That cushion is shrinking. Leanne Yanni, MD, president and CEO of Hospital Sisters Health System’s Illinois physician enterprise in Springfield, Ill., is watching the shift accelerate in real time — across the 320 physicians and advanced practice providers who serve 60 core locations spanning central and southern Illinois.
“The evolution of population health and accountable care is moving to downside risk,” Dr. Yanni said during a recent “Becker’s Healthcare Podcast” interview. “Many ACOs are moving to downside risk just like our organization.”
The Illinois physician enterprise is part of an accountable care organization navigating that transition, and was also selected to participate in the TEAM model, the CMS mandatory bundled payment program that launched in January 2026 and covers five surgical episode types. The program requires participating hospitals to manage costs and quality for the 30 days following discharge, and most participants will face two-sided risk beginning in 2027.
TEAM participation isn’t only a compliance obligation — it’s generating population health strategies HSHS intends to apply across the broader ambulatory enterprise. The model’s requirements, which include screening for health-related social needs and connecting patients to primary care services, align with the direction she’s already pointed the organization.
“We have a lot of public health data that is available to us to tell us in each area what the top morbidity and mortality drivers are and then nuancing and adjusting our practices from a clinical aspect to make sure we’re prepared to do more prevention in those areas based on the public health data,” she said. “That’s something I want to bring the teams along with a little further. I have some public health background and that’s really important to the application of our services in an ambulatory group.”
Dr. Yanni has pushed the Illinois Physician Enterprise to connect its community health needs assessments and community health impact plans to specific clinical decisions — something she sees as an underdeveloped lever in ambulatory medicine. The data now being collected is available at a level of granularity most ambulatory leaders haven’t fully engaged with.
“We know statewide data down to the census tract is available to us,” she said. “Using that, not just for the comorbidities and such, but also for social determinants can really help us make a stronger impact in our communities.”
The geographic complexity of the Illinois Physician Enterprise makes that work both more urgent and more challenging than it would be in a single-market urban system. The enterprise stretches from the Springfield metro area through rural counties in central and southern Illinois, where social determinants — transportation gaps, limited broadband, economic precarity — compound the clinical challenges that population health programs are designed to address.
Translating that data into practice requires a care delivery model built around it. Dr. Yanni is pushing toward integrated team-based care, particularly in primary care, as the mechanism for closing the gap between population health intelligence and clinical action.
“What we want to be able to do is have every single member of the clinical team be practicing at the top of the license,” she said.
In-basket management has emerged as a specific focus because while artificial intelligence can handle clinician inbox organization, prioritization and some responses, there are limits to its usefulness.
“In basket management is a killer for so many people. And I know there’s hope that AI will help manage it. It still is so nuanced that you need humans in the basket to manage these messages,” she said.
The solution, in her view, is distributing that work across the clinical team rather than concentrating it on physicians, freeing the face-to-face time that both population health management and patient experience require.
That model depends on operational standardization the enterprise hasn’t fully achieved. The Illinois physician enterprise was assembled through acquisitions and still carries the variability that structure produces: practices that function somewhat independently, workflows that differ across sites. Bringing those into alignment, the central work of Dr. Yanni’s first 18 months, is the precondition for the data-driven, team-based approach she is building toward.
Hospital Sisters Health System returned to operating income in the first half of fiscal 2026 after a period of operating losses, giving the enterprise some room to invest in that infrastructure. But the pressure is already registering and reimbursement headwinds are affecting the enterprise’s realization rates, making it harder to be paid at the rates the organization bills.
“We’re watching that happen right in front of us,” she said.
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