Empowering people with physical disabilities through the use of cloud computing so they could be brought back in the “normal world”.

Thierry RolinaMKT624 Winter 2011

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INTRODUCTION...........................................................................................................................................3ENVIRONMENT ANALYSIS.....................................................................................................................3

Overview.................................................................................................................................................... 3Current Interaction between the disabled and their environment............................5

Value creation.......................................................................................................................................... 5Current state of Co-creation in the existing value chain.......................................................7

Co-creation between the disabled and the government..................................................7Co-creation between the disabled and the communities................................................9

Conclusion and proposed way forward.......................................................................................9ENGAGEMENT PLATFORM OPPORTUNITIES.............................................................................10

Engagement between the government and the communities.........................................11Current DAT...................................................................................................................................... 11Proposed DAT.................................................................................................................................. 11

Engagement between the government and the disabled..................................................11Current DAT...................................................................................................................................... 11Proposed DAT.................................................................................................................................. 12

Engagement between the communities and the disabled.................................................12Proposed DAT.................................................................................................................................. 12

Design of platforms............................................................................................................................ 12Capabilities required......................................................................................................................... 12Challenges -> human for most of them......................................................................................12

Conclusion................................................................................................................................................... 13References................................................................................................................................................... 14

(1) 2006 American Community Survey Content Test report.....................................14(2) The elephant in the waiting-room...................................................................................15(3) HealthDay News......................................................................................................................17(4) Creating Public Value through Private / Public Partnerships .................................17

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INTRODUCTIONThis paper aims at applying some of the co-creation concepts studied in MKT624 in the public and social sectors to explore how people with physical disabilities can be empowered and brought back in the normal life. The first section provides some background data and highlights the current status of co-creation. The second section offers possible enhancements to the current situation.

ENVIRONMENT ANALYSIS

OverviewCensus data provides meaningful insight into what disability really is. Disability was first used in the 1880 census, and was used until 1910. At that time, disability had a completely different connotation and was rather related to primary health conditions such as sensory conditions, health conditions, deformities… Disability then disappeared until 1970 when it re-surfaced in the census with a focus on its economic impact and more specifically limitations to working at a job. Based on this data, Congress passed the rehabilitation act of 1973.

Below are some excerpts of the Rehabilitation act of 1973:

Congress finds that--

(1) millions of Americans have one or more physical or mental disabilities and the number of Americans with such disabilities is increasing;

(2) individuals with disabilities constitute one of the most disadvantaged groups in society;

(3) disability is a natural part of the human experience and in no way diminishes the right of individuals to--

(A) live independently;

(B) enjoy self-determination;

(C) make choices;

(D) contribute to society;

(E) pursue meaningful careers; and

(F) enjoy full inclusion and integration in the economic, political, social, cultural, and educational mainstream of American society;

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(4) increased employment of individuals with disabilities can be achieved through implementation of statewide workforce investment systems under title I of the Workforce Investment Act of 1998 that provide meaningful and effective participation for individuals with disabilities in workforce investment activities and activities carried out under the vocational rehabilitation program established under title I, and through the provision of independent living services, support services, and meaningful opportunities for employment in integrated work settings through the provision of reasonable accommodations;

(5) individuals with disabilities continually encounter various forms of discrimination in such critical areas as employment, housing, public accommodations, education, transportation, communication, recreation, institutionalization, health services, voting, and public services; and

(6) the goals of the Nation properly include the goal of providing individuals with disabilities with the tools necessary to--

(A) make informed choices and decisions; and

(B) achieve equality of opportunity, full inclusion and integration in society, employment, independent living, and economic and social self-sufficiency, for such individuals.

A recent report covering disability (1) (US census bureau) identifies four basic areas of functioning that identified the largest component of population of people with disabilities: vision, hearing, mobility, and cognitive functioning. According to the 2006 ACS survey, 15.1% of the population - about 41.3 million people - age 5 and above reported a disability. Of the population 16 years and over, 5.5% reported a go outside disability (mobility), and those 16 to 64 years old 7.1% reported an employment disability. Disability prevalence was highest among the 65 years and older population at 41% compared to rate for the 16 to 64 years age group (12.3%), and 5 to 15 years age group (6.3%).

In summary, disability has societal and economic impacts and these impacts are prone to worsen as people live older. It is urgent for the communities and the government to act and try to mitigate these impacts by bringing the disabled back into the “normal life”.

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Current Interaction between the disabled and their environmentOur baseline value chain consists of the following entities:

- The governments – comprising federal, and state- The communities – comprising the cities, the working and living

communities- The NGOs- The disabled themselves

The federal government is the legislating body. The federal government, through the social security administration, provides assistance to people with disabilities via disability insurance (DI) and supplemental income (SSI). According to the Economist (2), DI accounted for around 18% of social security spending in 2009, up from 10% in 1989. Still according to the Economist, the rules defined by the federal government for DI eligibility are ill defined. Disabled interact with communities when they work, live, consume… MIUSA.org references around 100 NGOs in the United States. These NGO, are usually very focused, either geographically or around types of disability. Their goals vary from the promotion of interests of the disabled to the improvement of their life.In summary, there are numerous entities all along the value chain that have the potential to interact independently with the disabled. There is little communication between these entities if communication is not needed. In the case of communities communication with government is reduced to compliance. All of this creates a climate in which the governments legislate, with the risk of producing laws that are ill effective and expensive.

Value creationUnlike in the private sector there is no notion of shareholder value in the public and social sectors. The notion of value is subjective and commensurate to the level of service provided. In “creating public value through Private/Public Partnerships”, Mark H. Moore (4) asserts that value may not be the maximum welfare for the maximum number of individuals but rather what we can collectively agree we

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would like to achieve using the powers of the state. This ultimately requires new models that can be inclusive for all stakeholders. We can safely say that value is created for the disabled as soon as their condition can be improved. In the case of physically disabled, that would mean improved mobility and interaction with the outside world.The equation is a little more difficult to describe when it comes to communities. For instance, compliance to the fair housing act can be first perceived as a cost to society. On the other hand, the first to comply will build an image of “fair player”, which will ultimately bring respect and value. There is also the opportunity to broaden the market by opening the services to a new segment of customers.

Value creation for the disabledValue is created through solutions to needs of the disabled.Numerous technologies today have the ability to bring value to the disabled by providing some of the functions that they have lost. For instance, a person with reduced mobility may enjoy his/her freedom again by using an electric wheel chair. Another example comes to mind with earing aids, which have become very common today.Social groups are working closely with the disabled; they range from special interest groups such as sports to general-purpose activities such as the best place to live. The Guidestar database references 801 NGOs in the United States dedicated to the physically disabled. More than half of these associations have less than $1M in income and $1M in assets. Facebook has a section dedicated to disabled.

Value created for the government The social security insurance pays benefits to the insured disabled, which could be an open door to a blank check if no close monitoring process is in place. This is the case for mental illness and back pain – a subset of musculoskeletal disorder – which represented respectively 22% and 31% of DI awards in 2009. The opportunity to better legislate would translate into a cost saving opportunity for the social security administration. Another example is obesity - a subset of mobility disability – which is estimated to cost $270 (3) billion per year of which $120 billion are in excess medical care. Closed-loop monitoring of the condition (active diagnosis and suggestion of procedures) would also translate directly into cost savings.

Value created for the communitiesFirst, economic value is created as communities have access to a larger pool of consumers. Disabled individuals and their families have a discretionary spending power that tops $200 Billion annually. The challenge here will be to have the ability to answer the special needs of the disabled. For instance, physically disabled often need special housing.

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Second, greater awareness is required to make communities disabled-aware and help elected official understand that people with disabilities are not burden or charity cases but contributing members.

Current state of Co-creation in the existing value chainIn this section, we will look at the various co-creation initiatives that have been taken by the stakeholder along the value chain.

Co-creation between the disabled and the governmentThe government has launched numerous initiatives to build awareness on disability.

disability.govDisability.gov is an award-winning federal government website that provides an interactive, community-driven information network of disability-related programs, services, laws and benefits. Through the site, Americans with disabilities, their families, Veterans, educators, employers and many others are connected to thousands of resources from federal, state and local government agencies, educational institutions and non-profit organizations. Since July 2009, Disability.gov has implemented both social media and personalization tools, offering an enhanced experience for all visitors. Among the new features is the ability to register for a My Disability.gov profile , which allows users to vote and comment on resources participate in group forums and view additional resources that are recommended based on their actions on the site. Visitors can also follow daily tweets on Disability.gov’s Twitter account, connect with other fans on Facebook and LinkedIn or read weekly guest blogs from experts on disability issues on Disability.Blog.

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Yet, despite this effort, a brick wall exists between the disabled and public sector. Statistically, seventy percent of all SSD (a.k.a. SSDI) and SSI claims are denied at application. This practically means for SSD and SSDI applicants that they need to seek help either from NGOs or from a disability attorney if the want to increase their odds of having their application accepted.

I can campaignThis campaign airs on YouTube at https://www.youtube.com/watch?v=BG_W7wAe1kw&feature=player_embeddedThe Campaign for Disability Employment is a collaborative effort to promote positive employment outcomes for people with disabilities by encouraging employers and others to recognize the value and talent they bring to the workplace.

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The video had only 34,370 hits since its launch on September 2009.

Co-creation between the disabled and the communitiesThese efforts are mainly driven by non-profit organizations

Non profit organizations Since 1991, project Genesis has been providing assistance to disabled in Connecticut. The organization acts as a seeker-solver portal and provides job development, job assistance and job coaching services through funding from the bureau of rehabilitation. Project Genesis has a network of employers in every industry and at every level of employment. Hiring employers get a federal tax credit up to $2400 per employee.

CommunitiesMost large cities have a Mayor’s office for people with disabilities. The office promotes participation and equal opportunity for people with disabilities.

Conclusion and proposed way forwardInsofar, our research shows an intent at co-creation from the federal government through disability.gov but the site lacks on the three dimensions of accessibility, dialog, and transparency.On the dimension of accessibility, the government must address the concern raised by www.pewinternet.org. In essence, even though the disabled seem to be more attached to technology in their home, computers are the exception. 56% of the disabled have or use a computer compared to 72% of all Americans. Regarding dialog, people with disabilities perceive the use of Internet to be confusing and hard to use (21% of the disabled v. 9% of the non-disabled). Finally, there is little –to no transparency to information in disability.gov.

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I have not found any similar initiative that links the communities to the disabled. This is an area where non-profit organizations are active. From what I could see, there seems to be a “do not care” attitude about the disabled from the communities; the small amount of hits for the “I can“ campaign warrant this. What we will explore next are ways to improve the government and the communities understanding of the disabled needs so proper dialog and true co-creation with the disabled can be started. But before co-creating between the blue and the yellow, we will first pay close attention at co-creating within the blue world.

ENGAGEMENT PLATFORM OPPORTUNITIESAs previously stated, disability.gov can be tuned to become a co-creation platform.The first motivation is that the disabled get medical coverage through Medicaid and Medicare, so the platform could be used to enroll on line, check benefits, and access services that would potentially bring the disabled into the stream of normal life. It will be key to enroll all the stakeholders into the design of the platform, particularly NGOs and city government, as they represent the closest link to the disabled.

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Engagement between the government and the communities

Current DAT

Dialog - LowThe dialog between the government and the communities is administered through the Mayor’s office for people with disabilities in large communities.

Accessibility - lowOnly a handful of large cities have a web portal: NYC, Chicago and Houston. In other metropolis, there is no such facility.

Transparency – lowWhenever it exists, the site provides little transparency into the various government initiatives.

Proposed DATThere is a tremendous opportunity to build awareness for the disabled needs in the communities regardless of their size. As stated previously, there is a need to make the communities disabled-aware and help elected officials understand that disabled are not a burden but rather represent an economic and social potential.

Dialog and AccessibilityDialog between government and communities should be enhanced by NGOs and/or charities through regular dialog with the communities. Several forums can be used and among others: meetings, local radio talks come to mind.

TransparencyIncreased transparency can be provided to communities by explaining the economical and social benefit of transparently caring for disabled

Engagement between the government and the disabled

Current DAT

Dialog - LowThe current platform is used as a one-way channel from blue to yellow although blog posting is available. There is no way for the disabled to post what their expectations and aspirations are.

Accessibility - highThe website is always available, although there is apparently reluctance from this users group to use the Internet.

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Transparency – mediumThe site provides some level transparency into the various government initiatives.

Proposed DAT

DialogFirst dialog should be initiated by the charities and the various NGOs working in the field. They know most the needs of the disabled hence they will be able to overcome their resistance to adopt and embrace the new engagement platform.

AccessibilityDisability.gov should be re-designed to be more user-friendly. A new voice-control front end would be a plus so arm- and hand- disabled can also use the platform.

TransparencyWe propose to extend disability.gov to include a secured access so disabled can log in, and check their status, fill forms…We propose to add a blogging section for the communication with the government agency. For example, a physically disabled person may be interested to go back to work, but he/she is encountering difficulties. A section dedicated to difficulties may be appropriate too.

Engagement between the communities and the disabled

This is an area where NGOs and charities are very active and by no means do we want to replace them.

Proposed DATWe propose to extend disability.gov to extend its reach to the local community. Disability.gov should provide a job portal available so the disabled can log their resumes, capabilities, skills… for those who wish to return to work. A similar capability should also be offered to employers.

Design of platformThe extensions proposed will require a re-design of disability.gov particularly in the areas of:

- Providing a secured access- Providing voice control access to the site- Re-designing the site front end so it is user friendly and easy accessible to

non-computer literate people- Providing blogging capability and semantic analysis– a key component to

analyze trends in needs

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In addition, NGOs and charities will have to work closely with the government, as these organizations understand the needs of the disabled. Getting the new platform adopted by both the communities and the disabled will decide of its success. I view the new platform potentially evolving into a nodal component, which could attract new businesses and ventures in the future.

ConclusionFor the first stage of the co-creation engagement, using cloud computing does not seem to be a necessary component. It will be key to first engage the communities through NGOs and charities and bring awareness that there is value for everybody in bringing back the physically disabled in the normal world.I would recommend piloting the engagement at a local level in a mi-size city that has a diversified industrial landscape.

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References

(1) 2006 American Community Survey Content Test report

After reviewing the results of the 1996 NCS in terms of reliability and validity and presenting the information to a group of experts, including the Interagency Subcommittee on Disability Statistics, the Census Bureau found that still more questions remained and the choice was not clear. Hence, another federal interagency work group was convened in June 1997 by the Office of Management and Budget and charged with the development of a short set of disability questions. The interagency work group faced three tasks in a short period of time: (1) measuring disability using a definition in keeping with the ADA, (2) meeting the needs of various agencies requiring specific information, and (3) having a maximum of six questions. The work group agreed that three domains (sensory, physical, and mental/emotional/cognitive) sufficiently represented the broad classification of impairments and health conditions that generally resulted in disability. Additionally, the work group concluded that it could meet an array of other policy and programmatic requirements with three questions on difficulty with specific types of functional activities. Their questions intended to address people with limitations in performing the following: Activities of Daily Living, which generally include self-care type activities suchas bathing or dressing; Instrumental Activities of Daily Living, which are activities oftenassociated with independent living such as going out alone to shop or visit a doctor's office; and, finally, working at a job or business. The work group’s consensus set of questions was put on the Census 2000 long form and on the ACS. (For further discussion of the research and analysis undertaken by this work group, see Adler et. al.)

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(2) http://www.economist.com/node/18332928?story_id=18332928

Disability payments

(2) The elephant in the waiting-roomPoliticians are ignoring a big, dysfunctional programme

Mar 10th 2011 | LAKE COUNTY, INDIANA | from the print edition

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It only hurts when I work

THOMAS SCULLY has a busy law office in Lake County, Indiana. He mainly practices disability law, with good reason. Lake County is home to steel mills. Workers have aching backs and hands warped by machinery. Mr Scully helps them win Social Security Disability Insurance (DI), which provides cash and, after two years, access to Medicare, government-subsidised health insurance meant mainly for the elderly. DI is not supposed to be a safety net for the jobless. “I tell clients”, Mr Scully explains, “disability insurance is not unemployment insurance.” But they should be forgiven for being confused.

Politicians like to deride expensive programmes. DI may be the least discussed and most muddled. The programme is severely strained. The number of awards has spiked in the downturn, rising 28% since 2007. This surge follows decades of growth. DI accounted for about 10% of Social Security spending in 1989 but 18% by 2009. This is not because beneficiaries are bending any rules; the real problem is that the rules are a mess.

Congress created DI in 1956. Since then physical labour has become less common, while medical technology has advanced. One might have thought that DI rolls would shrink, but the opposite has occurred. Even compared with the Social Security Administration’s other costly programme for the disabled, DI is huge. Supplemental Security Income (SSI), which gives help to the very poor, doled out $43 billion to adults and children in 2010, up 124% since 1990. DI gave $110 billion to disabled workers, up almost 420%.

The reasons for this are debated. States have an incentive to keep their welfare rolls low, so they may be pushing workers towards the federally funded SSI and DI programmes, argues Nancy Shor of the National Organisation of Social Security Claimants’ Representatives, a lawyers’ group. But unlike SSI, DI is not a substitute for welfare; DI requires beneficiaries to have worked for five of the past ten years.

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Ageing would seem another obvious explanation, as those aged 50-64 account for almost 60% of DI awards. But the rolls grew quickly even when the share of 50- to 64-year-olds was steady, according to David Autor of the Massachusetts Institute of Technology and Mark Duggan of the University of Maryland. Obesity does not seem to be the main cause either. Beneficiaries claiming problems such as diabetes and heart disease comprised a sliver of the awards in 2009.

A more likely culprit is the programme’s structure. Messrs Autor and Duggan show that DI awards have become more attractive to those struggling in the labour market. Those awards, meanwhile, have become more accessible. In 1984 Congress made it easier for DI applicants to claim mental illness and musculoskeletal disorders such as back pain—both inherently subjective ailments. In 2009 these two conditions accounted for 22% and 31% of DI awards, respectively, about double their share in 1981. Even if an applicant does not meet DI’s basic medical requirements, he may eventually win payments for other reasons. DI’s rules, for example, allow an older worker unlikely to retrain to get benefits instead. Persistent applicants can seek the help of lawyers. Of those who appeal their case to a judge, almost 90% are successful.

Given DI’s design, it should come as little surprise that enrolment jumps during recessions. Till von Wachter of Columbia University offers three explanations. First, impaired workers may be among the first to be sacked. After they are laid off, they may find that they qualify for DI, as is the case for many of Mr Scully’s clients. Second, DI’s criteria explicitly include economic factors, such as the ability to retrain. Third, those desperate for cash may use more subjective criteria, such as mental illness and “bad back”, to try to win benefits. Many will fail, but they can appeal.

The Social Security Administration has tried to fix some of these problems. The “ticket to work” programme, for example, is intended to help DI and SSI beneficiaries get jobs. But as of November 2010, just 2.4% of those offered job help actually received it (let alone found work). A newer pilot also encourages those on the rolls to find jobs. Such programmes seemed doom to fail, trying to convince beneficiaries that they can find work after they have spent years arguing otherwise. More effective, says Richard Burkhauser of Cornell University and the conservative American Enterprise Institute, employers should be given incentives to accommodate workers at the onset of their disability. A separate plan by Messrs Autor and Duggan, for the centre-left Hamilton Project, calls for all employers to offer disability insurance.

A solution is needed, and soon. The DI trust fund is expected to dry up in 2018, 22 years before the trust fund for Social Security retirees does. Nevertheless, budget hawks have flown over the issue. Barack Obama’s deficit panel said proposals to reform DI would be “critical” but were “beyond the scope of this commission.” Last year Paul Ryan, a Republican congressman, presented a bold plan for reforming entitlements. Of DI, the plan said simply: “disability benefits will see no change.”

(3) HealthDay News

MONDAY, Jan. 24 (HealthDay News) -- The economic cost of overweight and obesity is estimated at $300 billion per year in the United States and Canada, with 90 percent of the total cost attributed to the United States, according to a study published in December by the Society of Actuaries.

Donald F. Behan, Ph.D., from the Georgia State University Center for Risk Management and Insurance Research in Atlanta, and colleagues reviewed almost 500 research articles on obesity and associated

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morbidity and mortality. The study examined the economic costs resulting from increased requirements for medical care, loss of economic productivity due to excess mortality, and disability.

The investigators estimated the total economic cost of being overweight (body mass index [BMI] between 25.0 and 29.9) and of obesity (BMI at or over 30). The main economic costs included excess medical care ($127 billion), loss of productivity due to excess mortality ($49 billion), economic loss of productivity for active workers due to disability ($43 billion), and loss of productivity caused by total disability ($72 billion).

"The total economic cost of overweight and obesity in the United States and Canada caused by medical costs, excess mortality, and disability is approximately $300 billion per year. The proportion of this total due to overweight is approximately $80 billion and approximately $200 billion is due to obesity," the authors write.

(4) Creating Public Value through Private / Public Partnerships

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