Bring a large pot of water to a boil. Cook the macaroni to al dente according to the package instructions.
Melt the butter in a saucepan over medium heat and add the milk and half-and-half. Add the Cheddar, Parmesan, Romano, cream cheese, Dijon, Worcestershire and a pinch of black pepper, mixing well until combined. Whisk in the flour and cook for 2 minutes.
Combine the macaroni with the cheese sauce. You can serve it as is, or bake it for a more crispy finish. If baking, scatter extra grated cheese across the top and bake at 350 degrees F for 10 minutes.