For hospitals and health systems, the pressure is real. Costs keep climbing, margins are tighter than ever, and the shift to value-based care isn’t slowing down. It’s a lot to manage. Many leaders are asking the same question right now: how can we grow without stretching ourselves too thin?
That’s where MSOs come into the picture.
Management Services Organizations are helping hospitals rethink how they scale. Instead of trying to do everything in-house, more systems are looking to partner with MSOs that bring operational support, administrative infrastructure, and expertise in non-clinical functions. It’s not about giving up control. It’s about building partnerships that make sense for today and for what’s coming next.
When it works, a hospital–MSO relationship plays to the strengths of both sides. Hospitals focus on what they do best: care delivery, clinical quality, and community trust. MSOs step in with tools and systems that help run the business side more efficiently. That might include revenue cycle management, payer contracting, staffing support, or analytics. But success doesn’t come from plugging in a template. Every hospital is different. Every MSO is different, too. What works in one market might fall flat in another. That’s why alignment matters so much. From the start, both sides need to be clear about goals, decision-making, and what success looks like.
Some systems turn to MSO partners to support risk-based contracts or scale outpatient services. Others are trying to grow their physician networks without adding more administrative weight. In both cases, the MSO model can provide flexibility, structure, and speed, without hospitals having to reinvent the wheel. From the MSO’s perspective, partnering with a trusted health system adds credibility and clinical depth. It opens doors to new patients, stronger payer relationships, and better outcomes when the partnership runs smoothly.
That said, not every deal is a win. A mismatched partnership can create friction. If incentives aren’t aligned or communication breaks down, things can stall fast. That’s why governance, transparency, and trust aren’t just buzzwords here. They’re the glue that holds everything together. For investors, MSOs offer a growth path that can be more stable than traditional provider roll-ups. But it’s not just about scale. It’s about whether the MSO can adapt, whether it can build real relationships with providers, and whether it stays focused on patient care—not just margin.
Hospitals exploring this route should ask practical questions up front: What are we trying to solve? Where do we need help? How will decisions be shared? The best partnerships come from a place of honesty, not urgency. The healthcare system isn’t getting simpler anytime soon. That’s why more hospitals are looking for smart partners, not just service vendors. MSOs can bring structure to complexity, speed to strategy, and breathing room to clinical teams trying to do more with less. Done right, these partnerships create more than efficiency. They create space for hospitals to lead with care—not just survive another quarter.
Over the past 10 years, hospital health systems have increasingly formed joint ventures with outpatient Management Services Organizations (MSOs) to optimize operations, expand service offerings, and share financial and operational risks. The structure and volume of these joint ventures vary depending on the geographic region and specific market dynamics.
The largest players with around 10 major joint ventures targeting the ASC and outpatient care market.
Approximately five joint ventures with smaller non-profit systems spread across multiple states.
Several partnerships focused on outpatient and ASC development, primarily in California and Arizona.
Over the past 10 years, hospital health systems have increasingly formed joint ventures with outpatient Management Services Organizations (MSOs) to optimize operations, expand service offerings, and share financial and operational risks. The structure and volume of these joint ventures vary depending on the geographic region and specific market dynamics.
We at SCALE suspect this information is directionally accurate and important to share, but we have only been able to get into some of the back-up data – the primary driver of this supporting information is press releases which are had to tabulate over decades.
GoHealth Urgent Care has established multiple joint ventures with health systems like Dignity Health, Northwell Health, and Novant Health to expand urgent care services in states like California, New York, and North Carolina.
Emory Healthcare and PeachTree Immediate Care in Atlanta, Georgia, entered into a partnership to build and manage over 20 urgent care centers.
Cleveland Clinic and American Family Care have partnered to operate several urgent care centers in Northeast Ohio, integrating them into the larger health system’s continuum of care.
Pacific Dental Services and Midwest Dental partnered to integrate dental care into primary care facilities.
US Anesthesia Partners continued expansion with CHRISTUS Health in Texas.
Children’s Hospital Colorado joined forces with University of Colorado Health to expand pediatric specialties.
OrthoIndy and Community Health Network launched a dedicated orthopedic hospital in Indiana.
United Surgical Partners International (USPI) and TriStar Health partnered to create and manage new surgery centers.
HSS and Cedars-Sinai formed a JV for a musculoskeletal-focused outpatient center in Los Angeles.
Providence Health partnered with Fairfax Behavioral Health to develop a new 100-bed behavioral health facility.
Orlando Health and Acadia Healthcare announced a JV to expand behavioral health services in Florida.
Cleveland Clinic partnered with American Family Care to integrate urgent care centers into its network.
Surgery Partners and HealthONE formed a JV targeting outpatient surgery expansion.
Smile Brands entered a partnership with Midwest Dental to build dental clinics adjacent to primary care facilities.
US Oncology Network collaborated with Baylor Scott & White Health to create cancer treatment centers.
Intuitive Health partnered with CommonSpirit Health for hybrid ER and urgent care models.
Tenet Healthcare expanded its JV with Baylor Scott & White to include multispecialty outpatient services.
Outpatient Imaging Affiliates developed a new imaging network with UNC Health.
Ascension and Emerus Holdings developed a micro-hospital network.
Optum partnered with Northwell Health to manage primary care clinics.
Atlantic Health and MedExpress formed a JV for urgent care services.
Providence Health and Universal Health Services launched a freestanding behavioral health facility.
St. Louis Children’s Hospital and Shriners Hospital partnered for pediatric orthopedic care.US Anesthesia Partners continued expansion with CHRISTUS Health in Texas.
DaVita and Trinity Health created a JV to manage inpatient and outpatient dialysis services.
HCA Healthcare and Sarah Cannon Cancer Institute expanded a cancer research and treatment network
OrthoVirginia entered a JV with Bon Secours Health for comprehensive orthopedic services.
Children’s National Hospital and HCA Healthcare collaborated to provide expanded pediatric care.
Fresenius Medical Care and Intermountain Healthcare created a JV to manage dialysis services in Utah.
Tenet Healthcare and Mednax partnered for women’s health and maternal services.
Smile Brands and Optum launched a dental care JV, targeting integration with existing primary care facilities.
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