Navigating iOS 26 and the future of patient feedback
In September 2025, Apple released iOS 26, introducing new features that help users screen unknown callers and text messages. These updates are designed to give people more control over their mobile experience, deciding what gets their attention and what doesn’t.
For healthcare organizations that rely heavily on SMS and phone-based outreach, this shift introduces a real and growing risk. Messages may be delivered, but increasingly never seen—and response volume may erode faster than expected. At the same time, organizations with access to trusted, embedded channels—like Epic’s MyChart—are far better insulated from these changes. While SMS and phone-based outreach remain important—alongside established channels like mail and email—changes in how certain messages are filtered and surfaced can introduce new friction in an already complex engagement landscape.
This is not just another update about technology but an opportunity to understand the downstream implications and adapt thoughtfully. As the rules of outreach evolve, making sure patients are heard should remain steadfast; we’ll explore what that means in practice shortly.
What changed with iOS 26 and why it matters
iOS 26 introduces enhanced call and text screening, such as Screen Unknown Senders for SMS. When enabled, these tools filter or deprioritize messages and calls from numbers a user hasn’t saved. So, even when outreach is technically successfully, it may never reach the patient’s attentions, and organizations often have no visibility into which messages were effectively filtered out. For phone-based outreach, this also reduces the likelihood of real-time engagement, as unknown calls may be intercepted before reaching the patient.
These features are turned off by default, but Apple actively encourages users to enable them during system updates—and for users who previously opted into similar settings, they may already be active. But because overall adoption is difficult to quantify, the impact can vary significantly across populations.
Every organization that depends on SMS or phone-based engagement, regardless of industry, is navigating the same, new reality—one where consumers are harder to reach.
What the data shows so far
At Press Ganey, we’ve been closely monitoring how these changes impact response rates using a data-driven approach. Early directional signals suggest early but consistent degradation in SMS response rates, beginning around the iOS 26 release. While we can’t directly attribute causation, the timing and pattern are consistent with what we would expect from increased message filtering and broader industry trends.
That’s because iOS 26 is simply amplifying a trend that’s been building for years. Digital response rates—particularly for interruptive channels like SMS and push notifications—have been under pressure from increased filtering, constant alerts, and shifting consumer expectations. Patients, like every other type of consumer, are becoming more selective about who they engage with, and when.
These dynamics are especially challenging for phone-based and IVR surveys, which were already facing long-term engagement headwinds and now rely on a channel increasingly optimized to block unknown callers before they ever connect.
At the same time, other digital channels tell a different story. Email-only survey waves have shown relative stability over the past 18 months. While not immune to fatigue, email continues to offer a dependable baseline for engagement. All signals point to the idea that no single channel can carry the full weight of patient listening. As organizations start responding to these shifting channel dynamics, many are evaluating changes to how and when surveys are deployed, making methodological rigor especially important.
How Press Ganey can help you adapt with confidence
These dynamics are especially challenging for phone-based and IVR surveys, which were already facing long-term engagement headwinds, and now rely on a channel increasingly optimized to block unknown callers before they ever connect.
Press Ganey’s survey science is built for exactly this kind of environment. Because we adjust for survey mode, you can rebalance your outreach strategy, expanding email, incorporating patient portals, or testing new channels—all without breaking trendlines or losing comparability over time. This means you don’t have to choose between adapting and maintaining confidence in your data. You can do both. We also continue to actively monitor response patterns across our client base, using ongoing analysis to refine our guidance as these trends evolve.
Just as important, we don’t take a one-size-fits-all approach. Our teams work closely with you to evaluate response patterns across your organization, helping you understand where changes are occurring, why they matter, and what actions will have the greatest impact. In some cases, that may mean optimizing SMS—refining timing, frequency, or sender recognition.
We also recommend organizations take specific steps to strengthen SMS performance. Encouraging patients to save outreach numbers as contacts can help ensure messages are recognized and not filtered. Some organizations are making this easier by incorporating QR codes into registration or discharge workflows, allowing patients to quickly add trusted contact information to their devices. Small steps like these can improve survey response rates and patient communication in general.
But in many cases, the more durable solution is to continue to use a mix of digital channels. As digital noise continues to grow, attention becomes more valuable and harder to earn. That’s why some of the most effective listening strategies don’t compete for attention but align with it. One way to do so is to meet patients in the digital channels where they already are—such as in MyChart.
Delivered directly within Epic’s patient portal, MyChart surveys reach patients in a space they already use as part of their care journey. Unlike SMS or IVR, MyChart surveying isn’t dependent on caller ID or saved contacts—it lives inside a clinical environment patients already trust. MyChart surveying doesn’t rely on unfamiliar numbers, but instead shows up alongside test results, appointment details, and messages from care teams, embedded in an experience patients already recognize as relevant. That context matters.
MyChart as a complement (not a replacement)
MyChart is not a silver bullet, but it is one of the few channels whose effectiveness is not undermined by system-level filtering. The most effective organizations treat MyChart as part of a broader, multi-channel listening strategy. Rather than replacing existing outreach methods, they use MyChart to extend reach, deepening engagement with patients who are already active in the portal.
When deployed intentionally, MyChart can:
- Increase response rates among patients already active in the portal
- Engage younger and digitally fluent populations who may be less responsive to traditional outreach
- Capture incremental feedback that broadens and strengthens your dataset
It helps surface voices that might otherwise be missed—patients who are less responsive to real-time, interruptive outreach or who choose to engage within a trusted clinical environment.
When you engage your audience via MyChart, you can sustain—or even slightly improve—participation, while keeping a more accurate, representative view of the patient experience.
Build a more resilient listening strategy
We know SMS is not going away. The lesson we need to take away here is that no single channel is future-proof. Patient expectations and technology will continue to evolve, and the most successful organizations will evolve with them.
That looks like:
- Diversifying outreach across multiple channels
- Investing in platforms patients already trust
- Maintaining methodological rigor to protect data integrity
- Continuously monitoring and adjusting based on real-world performance
With the right foundation, change becomes manageable.
Looking ahead
iOS 26 won’t be the last—or the most aggressive—shift in how people control who and what reaches them on their devices. And attention will become even more selective. But the need to listen, to truly understand what patients are experiencing, won’t change.
Organizations that continue to rely on a narrow set of interruptive channels will feel this changes more acutely with each OS update. When your listening strategy is built with flexibility and continually monitored, you won’t lose momentum when outreach technologies change. You’ll keep moving forward with confidence and a deeper connection to the people you serve.