I don't think it is entirely far fetched - just, unexpected.
Lets say he survives his poisoning/bout of Malaria - but is now permanently weakened physically, and as such focuses on the Empire that he has built with his father.
He could do worse than take a leaf out of his fathers book and restructure the Empire like the Hellenic League - have himself ruling as King in Babylon and Macedonia, but rather than a system of appointed Satraps, have elected rulers, but have his Generals in the region with some powers i.e. requisition supplies as long as a note of reparation is given, stuff like that. He still has unequivocal say because of his army, and it allows the local Satrapic Republics to have a small force to handle banditry and provide some sort of reserve levy.
Plus, it also ensure he can set up seperate hierarchies between his Macedonian settlers and Generals, and the Satrapys. The Royal Cities (for lack of a better term) are under direct rule of the King (in practical terms, through his Generals), and provide a strong local base to counter the Satrapys. Throw in the responsibility of a Royal City Governor to collect the appropriate tithes of the local Satrapies, and handle some level of disputes, and the position of a Royal City Governor is still a pretty good deal.
In short, if Alexander wants to reign in the power of his Generals, as he might clock onto if he isn't a bullish personality-driven warlord anymore, elected Satraps isn't a bad way to go, he just needs some other way to reward his Generals (especially those who are already Satraps when he recovers from his illness)