The healthcare system is flooded with mobile apps—more than 165,000 are currently available in the Apple and Google app stores. Even though mobile apps have great potential to help with the most pressing healthcare problem in the U.S.—chronic disease—they are hardly making a dent in helping to provide a digital health solution.

That is the chief conclusion of a pair of Harvard business and medical researchers that just authored a controversial article now out in the Harvard Business Review. The Centers for Disease Control and Prevention estimates that chronic diseases account for 70% of U.S. deaths and 75% of U.S. healthcare spending, says Harvard professor of business administration of the Harvard Business School Health Care Initiative Robert Huckman.

Medical apps have great potential to help with improving treatment and the efficiency of chronic diseases including diabetes and others. For example, Twine Health, a Boston digital healthcare company, developed an app for managing chronic disease and prevention. Once a patient has been diagnosed with a chronic disease, their physician can set up a treatment program using the Twine app, including appropriate medication, exercise, dietary recommendations and routine patient monitoring of symptoms (for example, blood pressure for hypertensive patients, or blood sugar levels for diabetics), Huckman writes. The physician and the patient, along with a health coach, develop a management plan based on the patient’s individual needs and health goals. The app reminds the patient when they need to take a particular action or enter a specific piece of data. Through the app, the patient regularly connects with the coach, who initiates check-ins and answers minor questions related to the treatment protocol or the patient’s symptoms. When needed, the physician is consulted.

Early results show the app is being used. Twine, which was acquired by wearable-device maker Fitbit in February for an undisclosed sum, says it now has more than 25 million users.

But the mainstream use of mobile health apps is hindered by multiple business challenges, Huckman notes. “One challenge facing digital health apps is that they are difficult to sell directly to patients, making this group an unlikely source of paying customers,” Huckman writes. “Given that individuals are not used to paying for chronic disease treatment beyond standard co-pays for physician visits and prescription drugs, the costs of acquiring individual patients as customers are likely to be quite high.”

Consumers will pay to download an app for multiple reasons, especially entertainment, Huckman writes. But not so much for an app that dictates how a person must manage healthcare affairs. “CDM (chronic disease management) apps often dictate a set of behaviors (for example, exercise and dietary restriction) that many individuals would prefer to avoid,” Huckman writes. “Potential users thus see CDM apps that monitor health conditions and give medical advice as something for which the health care system—insurers or providers—ought to pay.”

To consumers, it may seem more suited for employers, health insurers and providers to pay for a chronic disease app for wellness and coaching—but those businesses and organizations also have their own reservations, writes Harvard assistant professor and on the faculty of Harvard’s Health Care Initiative and the Digital Initiative Ariel Stern. “As the bearers of financial risk for the health spending of these individuals, both insurers and self-insured employers have an incentive to use CDM apps to reduce healthcare costs or to improve the convenience and quality of care for their patients with chronic disease,” Stern writes. “Nevertheless, many payers still lack the ability to get individual providers—whom they contract and don’t employ—to use CDM apps actively.”

Even if healthcare companies do pay mobile app costs, getting patients, plan members and employees to use an app on a consistent basis is another challenge. “The same forces of denial and inertia that discourage patients from paying for digital health apps may also cause them to be less likely to use those apps, even when they are provided free of charge,” Stern writes. “For a CDM app to be effective, it must be adopted and used by both providers and their patients. Getting a payer organization to pay for it, therefore, is not enough.”

If chronic disease management apps are to play a bigger role in prevention and treatment, then it’s up to healthcare organizations and app developers to come up with apps, strategies and incentives that will drive more use. “Though many CDM apps provide the functions needed to manage chronic disease effectively, they still must overcome substantial institutional barriers to their sustained use,” Huckman writes. “By understanding the importance of managing several steps—adoption, diffusion, use and improvement —developers of CDM apps will improve the chances that their promising technologies will be successful in practice.”