; (bb) arrangements where such parties agree to preestablished cost or utilization targets and to subsequent significant financial rewards or penalties (which may include a reduction in payments to downstream providers or suppliers in the network) based on the performance of all such parties with respect to such targets; or (cc) other mechanisms that demonstrate significant shared financial risk (as defined in clause (i)) or significantly assist such parties in meeting risk-sharing targets, including shared-savings payments, withholds, or bonuses. Remuneration to parties who participate in a value-based risk-sharing network arrangement may be in-kind or monetary payments, which may but are not required to place the parties to such arrangement at financial risk (as defined in clause (i)). (iii) The term value-based risk-sharing transaction means a payment made under an arrangement under which each party agrees— (I) to contribute to the achievement of preidentified clinical or economic target metrics that are specifically tailored to improve patient outcomes or reduce the costs of health care delivery without negatively affecting patient outcomes; (II) to implement processes or procedures that otherwise optimize the delivery, efficiency, or quality of patient-centered care