You can easily substitute the Italian sausage with chicken sausage, ground beef, or ground turkey.
You can always add some leafy greens to the soup such as spinach or kale. If you decide to add any greens, just toss them in near the end of the cooking cycle as they don't take long to cook.
Rolling the sausage into mini meatballs is fun, but you can shorten prep time by simply browning the sausage in chunks.
You can use regular or whole wheat orzo here. We have successfully substituted an equal amount of pearl couscous for the orzo in this soup if you prefer to use that instead. Acini di pepe and even ditalini I imagine would be great as well!
Fire roasted diced tomatoes add a nice kick of heat. If you want your dish to be a little spicier I would recommend using hot Italian sausage or add a few shakes of red pepper flakes.