Under its Better Together programme, external the health board is proposing changes to services in a range of areas - adult physical health, adult mental health, urgent care and some diagnostic services.
Among the proposed changes, external, the most controversial could affect inpatient beds in most of Powys' community hospitals where occupancy rates are usually around 85 to 90%.
Powys does not have a general hospital, but it does have beds in eight community hospitals.
According to a report to the health board the current model "provides valued local services, but its dispersed configuration makes it increasingly difficult to meet needs consistently".
It will consult on two possible options:
The first option would see beds located in three community hospitals in Brecon, Newtown and Llandrindod Wells. This would mean a reduction from 146 to around 90 inpatient beds for the whole of Powys.
The second option would see beds located in two community hospitals in Brecon and Newtown. This would mean a reduction to around 60 inpatient beds.
Any changes would happen over a number of years.
A health board report said about 40% of its budget is spent on services commissioned from outside of Powys - in the last financial year this was around £198m.
There are also proposed changes to Powys' minor injuries units and the way urgent care is delivered in the county.
At the moment, urgent care is delivered in a variety of ways including by GPs, an out of hours service, pharmacies and health board minor injuries units.
But the health board believes the current service "does not provide consistent or equitable access across the county" and demand for urgent care is increasing.
Its is proposing two options for changes to urgent care and diagnostic services.
The first option would see urgent care available on three sites - Urgent Care Centres (UCCs) would be established in Newtown and Brecon, and a minor injuries unit in Llandrindod Wells, operating from eight in the morning until eight at night, seven days a week.
The minor injury unit would stay in Welshpool until the UCC opens in Newtown, and then the minor injury unit in Welshpool would close.
The second option would see just two UCCs in Newtown and Brecon.
One option for changes to mental health services is proposed - the consolidation of all adult and older adult mental health services at a single site, either at Bronllys hospital or a new site in the Bronllys/Brecon area, as well as expanding community mental health services.

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