You might not be using all of the available power. Some folks flinch when it comes time to put the pedal to the metal. If you are only seeing 45 mpg, even on a 6 per cent grade you need to put your right foot down. You can run that V-10 at 4 or even 5,000 rpm all day and the only harm done will be to your mileage.
I have yet to find a 6 or even 8 per cent grade that my 2012 E-350 Class C cannot climb at 55. Usually this involves brief periods in 3rd turning 4,000 to 4,200 rpm (max HP- 305), and you will have max torque (420), at 3,250. As noted NA gas engines lose approximately 3 per cent of their available power for each 1,000' of elevation.... as in 8,000' = 24 per cent less available HP.
If more throttle doesn't solve the problem check the easy things first; air cleaner, tire pressure and try running a couple of tanks of first tier gas Chevron/Shell etc. (but just regular). A fuel additive like Techron or even Sea Foam might get the critters out of a dirty tank. Good luck!
:C