Hidden, unless we are talking Hospital based programs or hospitals that own their own Pt.135 certificate, I am afraid the future of HEMS in the USA is slated to go Single Engine VFR with NVGs.
The two operators you mentioned are for profit, and since there's a limit to what they can charge the patients, they have to lower their overhead expenses.
My solution would be IFR ALL programs and helicopters with WAAS implemented GPS approaches and WX reporting for rurally funded helipads, NVGs where required, ACTIVE vs data based EGPWS.
Twin engine would be ideal; but let's face it, how many accidents have we had in HEMS because of total engine failures vs CFIT or other factors?
However this horse has been beaten before and has since been reduced to unrecognizable pulp.
This industry is profit driven and safety is more often than not merely paid lip service.