Two of California’s biggest insurers are setting aside competitive differences and pooling data, aiming to create the largest statewide exchange of health information in the country.

Anthem Blue Cross and Blue Shield of California announced that they are combining some 9 million patient records, making them available to hospitals and providers to improve coordination. The two insurers are seeking payers and providers willing to pitch in data, and are spending roughly $80 million to start the exchange, called the California Integrated Data Exchange, or Cal INDEX.

Those involved believe this effort to create a statewide HIE will succeed where others failed is because of its size and clear funding model. “Scale is critically important. Bringing that together — with roughly 9 million to-be-integrated records — is something that has not taken place before,” says Mark Morgan, president of Anthem Blue Cross. “And, frankly, the seed funding for the first three years is a point of differentiation, too. As we integrate many systems in those first years, we believe we’ll have the momentum necessary to continue forward on a self-sustaining basis.”

Morgan says the initial three-year plan calls for integrating about 30 accountable care organizations’ records into the mix. Members would join for free initially, but pay a fee after the startup period.

David Feinberg, M.D., chief executive officer of UCLA Hospital System and chair of Cal INDEX’s board of directors, believes such patient data, reaching back years, is key if providers are going to start taking on more risk.

The ability to vastly improve care coordination should convince payers and providers to take part beyond the first three years, but keeping data secure will prove crucial, too. “It’s really, really important for patients to see that their data is being used in the exact way that it’s intended, and never for ill gain,” Feinberg says.

UCLA Health System was one of seven hospital systems that joined with Anthem Blue Cross to offer integrated care in Los Angeles and Orange counties. The goal of the effort, called Anthem Blue Cross Vivity, is to improve the health of Anthem members while sharing in the financial risk of providing care.

Regarding the new HIE, hammering out the right fee structure is essential. In Massachusetts, health care leaders found that solo practitioners were only willing to pay about $5 a month for access to the exchange, while payers and academic medical centers might contribute much more, says John Halamka, M.D., chairman of the New England Healthcare Exchange Network. Cal INDEX would be wise to charge on a scale, and create aligned incentives so that every organization buys in. Never charge a transaction fee, which can discourage use, he says.

With exchanges running in Massachusetts and Indiana and in the works in New York and Vermont, the industry is taking small but positive steps, says Halamka, who also works as the chief information officer of Beth Israel Deaconess Medical Center and is co-chair of the federal government’s Health IT Standards Committee.

“We are in an era of biplanes, not yet jet aircraft, but we’re still flying,” he says. “You couldn’t go from the horse and buggy to a jet aircraft overnight. There was a period of interim steps. When you look at Massachusetts, Indiana and now California, they are steps along the journey.”