Career Spotlight

Gregory Dill, PharmD ’99

MPH Rear Admiral, U.S. Public Health Service and Deputy Office Director, Innovation and Financial Management, Centers for Medicare and Medicaid Services

BY JESSICA CANLAS

Dr. Greg Dill has found his calling.

This wasn’t exactly something he’d anticipated on an ordinary evening while working behind the pharmacy counter at one of the now-defunct Dominick’s grocery store locations in 2008. Nor had he expected his subsequent path to lead him, not indirectly, to his current position as a deputy director for the Centers for Medicare and Medicaid Services (CMS), the federal agency that provides healthcare coverage for more than 100 million people.

However, like many such extraordinary adventures, Dill began his journey from a fairly ordinary starting point. And without any particular destination. In fact, when Dill, a native of Philadelphia, Pennsylvania, graduated from high school, he admits that he joined the armed forces because he didn’t know what career path he wanted to pursue. And college wasn’t in his budget.

“You’d be amazed where poverty takes you,” he jokes.

In Dill’s case, it took him to the U.S. Army, where he served as a medic “in an armor battalion, of all places,” he reminisces. This curious placement ended up becoming his entrée into the healthcare space. Afterward, Dill went onto earn his associate’s degree in engineering and a bachelor’s in business and economics from Lafayette College in Easton, Pennsylvania. Because of his prior enlistment, Dill graduated with a commitment to return to the Army and was assigned, yet again, to an armor battalion. This time, he was given an administrative post managing more than 30 healthcare professionals. And, although he never saw any overseas deployments, Dill took the opportunity to observe and experience a variety of disciplines in the domestic healthcare arena.

“I realized I didn’t want to be a physician,” he recalls, “But I liked the science of drugs and the application of drugs, so pharmacy became attractive.”

So, after he’d fulfilled his commitment to the Army, Dill, who’d met his wife by this time, relocated to Chicago. He earned his PharmD at UIC in 1999 and then went to work for Searle, which was later taken over by Upjohn, which, eventually, merged with Pfizer.

It was 2003, and Dill found himself at a crossroads.

“The day we were told that we were closing down, another pharmacist asked me what I was going to do,” Dill says. “I’d just lost my job. I told him I didn’t know what I was going to do.” His friend recommended, based on Dill’s prior military service, that he consider applying for the U.S. Public Health Service. Following that sage advice, he did and ended up with a posting at the Food and Drug Administration, one of eight operating divisions of the U.S. Department of Health and Human Services that is designated as part of the Public Health Service.

As a commissioned corps officer, not only did Dill hold a full-time federal agency position; his military training proved critical while also serving part-time in the Public Health Service, which occasionally required him to don his uniform for short-term deployments to areas requiring emergency medical support. He recalls a memorable instance in rural Florida following a hurricane disaster.

“We came in and worked so people could go home and be with their families,” he says. “It was hard, working that night shift. You’d get on about ten at night and then leave at eight in the morning when people were walking in the door and the sun was rising. I remember doing aminoglycoside for a newborn, and there was this protocol the hospital was following, but I was so nervous, I triple-checked that thing four or five times and even had the nurse look at it too.”

It was during his time at the FDA, while reading a pharmacy industry publication, that Dill had a eureka moment. The same year he’d been laid off, the Bush administration

“I was reading about this massive legislation that, for the very first time,” Dill recalls, “was going to give millions of people drug coverage. Medicare was going to be enrolling 25 million people for this by the end of 2005.

“How could they not need pharmacists?”

Dill saw an opportunity and landed a meeting with the Chicago CMS administrator.

“I’ll never forget it. It was the Wednesday before Thanksgiving in 2005, and the gentleman said, ‘We haven’t historically hired pharmacists. I don’t know what we’d do with one.’ I said, ‘You have no idea. You’re about to roll out the biggest prescription drug benefit in the world.’”

Three weeks later, just before taking his holiday leave, Dill got a call back asking him how soon he could start. He began at CMS two weeks later in January 2005, focusing mainly on implementing the prescription drug benefit and working in outreach and education. Eventually, he was asked to consider a position that would take him to CMS headquarters in Baltimore to write policy. Dill, with more than a little trepidation, agreed to a four-month stint.

“Lo and behold, I liked it,” he remembers. “I wrote and rewrote every day. I read the law, read what people were suggesting about it. After a while, your anxiety decreases, and you get to a point where you sort of know what you’re talking about.”

At the time, Dill had still been working part-time as a night-shift pharmacist at Dominick’s. He recalls how their fax machine would print out all their directives during his shift.

“One night, I was sitting there, and out of the fax machine came a memo about vaccine administration. A memo I wrote came out of that fax machine at 7:45 at night! ”

As he progressed through his career at CMS, Dill also earned his master’s in public health. Then he found himself at a turning point—pursue the path of becoming a technical expert or delve into leadership. He opted for the latter and started on his path to deputy director with a position as an associate regional administrator for Medicare fee-for-service operations in the Chicago area. He was later promoted to regional administrator, then served as acting consortium administrator.

Today, he holds the deputy director post at a new arm of the CMS, the Office of Program Operations and Local Engagement Innovation and Financial Management, which was just instituted in November 2019. Dill’s office represents the front face of CMS across the nation by leading the administration of the Medicare fee-for-service program at the regional level, which serves more than 57 million beneficiaries and supports more than 1.6 million healthcare providers, physicians, and practitioners through oversight of Medicare administrative contractors, accountable care organizations, and CMS’s innovation models and ensures the Medicare program’s fiscal integrity.

According to Dill, his office is “fully focused on transforming how we pay for and support healthcare delivery in the U.S.” The innovative vision for CMS, he explains, is to reframe the traditional fee-for-service system—paying claims—into a more value-based model. So far, one of the ways they’ve begun to move in this direction is by implementing advanced alternative payment models, in which primary care organizations are allocated funds— prior to providing actual services—to direct as they see fit for their population.

“We recognize that primary care is changing,” Dill says. “Wellness doesn’t necessarily need an office visit.”

Since physicians are better acquainted with their own populations, Dill explains, they know best how to steward the funds they are given to provide the highest level of care to their communities at the lowest cost. Healthcare providers can be incentivized and rewarded for prioritizing quality of care over quantity of visits.

At the moment, approximately 30% of Medicare payments are based on some sort of value-based attribute. Dill wants to drive that statistic up to 50% within the next five years.

“Why? Because if we are asking people to change, we need to change our structure and approach to fit a payment system based on value. And it’s not just structure; it’s about the people we hire, the processes we implement, the quality of our data analysis. Can we use automation and digital tools to better support a beneficiary population that is becoming more technically savvy and expects to be able to do everything through their phones?

“We have to keep up.”

In his own life and career, Dill himself has set an example of living out that exact sentiment. But he admits it wasn’t an easy path.

“My life has not been some giant trajectory of success. I’ve been laid off. I’ve been turned down for jobs I really wanted. That CMS guy turned me down at first. I’ve had my failures along the way—and some painful ones.”

Yet Dill is adamant that today’s pharmacists, particularly those who are willing to think a little bit differently, have “unlimited” opportunities available to them. “But, like anyone, you’re going to fail. Then you’re going to have to get back up, try again, and just keep trying.

“You have to remember where you want to go. If you’re stuck in the here and now, you won’t go anywhere.”