For many healthcare professionals, Dr. Mary Naylor and her transformative Transitional Care Model (fondly referred to as the “Naylor Model”), have become synonymous with care transitions and readmission prevention. Adapted from a care transitions program for low birth weight infants, Dr. Naylor created one of the most influential models for caring for high-risk older adults. With amazing results in hundreds of healthcare organizations across the country, it has become one of the standards for managing a high-risk patient population. Now chair of the Care Culture and Decision-Making Collaborative through the National Academy of Medicine, Dr. Naylor continues to shape the future of healthcare through policy initiatives and research, including her recent 6-year term on MedPAC.